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(Circulation. 2007;115:2684-2686.)
© 2007 American Heart Association, Inc.

Editorial

Bleeding While Starting Anticoagulation for Thromboembolism Prophylaxis in Elderly Patients With Atrial Fibrillation

From Bad to Worse

D. George Wyse, MD, PhD

From the Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary/Calgary Health Region, Health Sciences Center, Calgary, Alberta, Canada.

Correspondence Dr D. George Wyse, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary/Calgary Health Region, Room G009, Health Sciences Center, 3350 Hospital Dr NW, Calgary, Alberta, Canada T2N 4N1. E-mail dgwyse@ucalgary.ca

Key Words: Editorials • anticoagulants • arrhythmia • prevention • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 

Growing old is like being increasingly penalized for a crime you haven’t committed.

— —Anthony Powell, Temporary Kings

Anticoagulation therapy for thromboembolism prophylaxis in patients with atrial fibrillation (AF) is based on quality information derived from numerous randomized controlled trials but continues to be a conundrum for many physicians. The AF treatment guidelines have been revised recently,¹ but new information is emerging at such a rapid rate that it is hard to imagine how the guideline process can keep up with the pace. In this issue of the journal, there is new and rather startling information derived from careful observation of the initiation of warfarin therapy in a cohort of elderly patients with AF.² Several aspects of this study deserve emphasis.

Article p 2689

	Key Points from Hylek et al

 
The subjects in the cohort of Hylek et al² possess some unique characteristics. The obvious one is the age of the patients. All were aged 65 years. It is equally notable that none of them had been on warfarin during the preceding year. A substantial proportion of women were included in the cohort. Among those aged 80 years, 55% were women. It is also notable that the duration of follow-up was restricted to the first year of warfarin therapy.

The most obvious finding to be emphasized is the high proportion of serious bleeding incidents. The reported amount of major bleeding during use of vitamin K antagonists over nearly 2 decades has varied (see Table 4²). There is, however, a discernible pattern over time. In general, . . . [Full Text of this Article]

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