Warfarin therapy is the cornerstone in the prevention of thromboembolism in patients with atrial fibrillation. It reduces the risk of stroke by two thirds in comparison with no anticoagulation.
1 A weak alternative to warfarin is aspirin, which is also effective over placebo in the prevention of stroke in atrial fibrillation.
1 Aspirin is safer than warfarin in general use. The incidence of atrial fibrillation sharply increases with age, but also the risk of bleeding from warfarin shows the same pattern.
2 Many physicians are reluctant to prescribe warfarin to the very elderly patient with atrial fibrillation because of the risk of bleeding, and many are convinced that aspirin is a wise and acceptable alternative. This was established in a Dutch trial in the primary care of patients with atrial fibrillation showing equal efficacy of warfarin and aspirin.
3 However, comparative data in the very elderly (over 75 years) are rather scarce.
4 Therefore, the recently published BAFTA (Birmingham Atrial Fibrillation Treatment of the Aged) trial was very welcome. …
