This educational article presents a clinical scenario to introduce a guide on evaluating the medical literature regarding the use of warfarin for stroke prevention in nonvalvular atrial fibrillation.
Do long-term anticoagulants (warfarin) reduce the risk of embolic stroke without excessive risk of hemorrhage in patients with nonvalvular atrial fibrillation?
This article presents a clinical scenario to guide physicians on how to review medical literature regarding anticoagulant use in nonvalvular atrial fibrillation.
CLINICAL SCENARIO You are a general internist who is asked to see a 65-year-old man with controlled hypertension and a 6-month history of atrial fibrillation resistant to cardioversion. Although he has no evidence for valvular or coronary heart disease, the family physician who referred him to you wants your advice on whether the benefits of long-term anticoagulants (to reduce the risk of embolic stroke) outweigh their risks (of hemorrhage from anticoagulant therapy). The patient shares these concerns and doesn't want to receive a treatment that would do more harm than good. You know that there have been randomized trials of warfarin for nonvalvular atrial fibrillation and decide that you'd better review one of them.
Gordon Guyatt (1994) conducted a review in Atrial fibrillation. Warfarin was evaluated. This educational article presents a clinical scenario to introduce a guide on evaluating the medical literature regarding the use of warfarin for stroke prevention in nonvalvular atrial fibrillation.