Clinical Correlation Between Effective Anticoagulants and Risk of Stroke: Are We Using Evidence-based Strategies?

OBJECTIVES: Despite evidence supporting anticoagulant use in atrial fibrillation, this modality is not fully utilized. METHODS: Retrospective chart review of 297 patients with nonvalvular atrial fibrillation between 1997 to 2000. 124 patients received warfarin and 166 did not; 91 patients suffered stroke. RESULTS: Age (P = 0.232) and gender (P = 0.745) were not determinant factors for starting anticoagulation prophylaxis. Whites were more likely to receive anticoagulation therapy than blacks (P = 0.043). Cardiologists were 4.5 times more likely to prescribe warfarin than neurologists and internists (P = 0.035). Neurologists (P = 0.305) and internists (P = 0.770) had similar warfarin prescription patterns and often with patients experiencing the highest rates of stroke. CONCLUSION: Lack of a uniform pattern in anticoagulant administration, despite multiple guidelines, is disturbing. Continuous physician education and community awareness by local and federal medical agencies is essential and cost-effective.