Abstract | BACKGROUND:
Stroke risk in nonvalvular atrial fibrillation can be reduced by warfarin or aspirin; the choice of therapy requires the assessment of risks and benefits. The authors compared methods of risk assessment and their implications for risk communication and treatment. METHODS: RESULTS: Framingham equations gave lower stroke risks overall than SIGN or SPAF. CHADS(2) was intermediate. Using SIGN, warfarin would be given to all 103 patients without a history of stroke/ transient ischemic attack and for whom warfarin was not contraindicated but only to 73 patients using the simple prediction rule and 48 patients using the decision analysis. CONCLUSION: Community-based cohorts give lower stroke risk estimates than CHADS(2); both give lower estimates than schemes from control groups from randomized controlled trials. Using community-derived risks would lead to fewer patients being treated with warfarin than guidance derived from randomized controlled trial controls, which may lead to many low-risk patients being treated with high-risk therapy. This raises the debate about appropriate sources of data for risk assessment to support risk communication and effective clinical decisions.
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Authors | Richard Thomson, Martin Eccles, Ruth Wood, David J Chinn |
Journal | Medical decision making : an international journal of the Society for Medical Decision Making
(Med Decis Making)
2007 Jul-Aug
Vol. 27
Issue 4
Pg. 438-47
ISSN: 0272-989X [Print] United States |
PMID | 17641140
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Aged
- Aged, 80 and over
- Anticoagulants
(therapeutic use)
- Atrial Fibrillation
(complications, drug therapy)
- Comorbidity
- Decision Making
- Evidence-Based Medicine
- Female
- Humans
- Male
- Practice Guidelines as Topic
- Risk Assessment
- Risk Factors
- Sex Factors
- Stroke
(etiology, prevention & control)
- Warfarin
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