1 VIEWS & REVIEWS

Warfarin has benefits, but be careful

Doctors considering giving warfarin as primary prophylaxis against stroke in patients with atrial fibrillation should:

• exclude patients with contraindications to long-tenn anticoagulant therapy

• regularly review patients' anticoagulant control

• ensure that rapid access to hospital is available in the event of potentially disabling or life­threatening bleeding.

Haemorrhage risk

Dr Gordon Lowe. of the Royal Infinnary. Glasgow. UK. made these recommendations after noting that moderate anticoagulant therapy with warfarin reduces the risk of stroke by two thirds in patients with atrial fibrillation.

However. it has the disadvantage of requiring regular monitoring. and increases the risk of haemorrhage. If not monitored carefully. warfarin therapy can in fact induce strokes with a higher morbidity and mortality than those it is given to prevent.

Additionally. in the general practice setting. conditions are usually more lax and patients less motivated than in the carefully controlled environment of a clinical trial. and thus

compliance and safety are less assured. [See this week's Pharmacoeconomics section, p7

for a Swedish cost-benefit study of the value of anticoagulant therapy in prel'enting stroke.] Lowe GDO. Antithrombotic !reatment and atrial fibrillation. Warfarin reduces the risk of first time strokes by two thirds. British Medical Journal

305: 1445-1446. 12 Dec 1992 800''''''''

19 Dec 1992 fNPHARMA® fSSN 0156.270319211912.0021$1.00° Adis International Ltd