Neurology and Preclinical Neurological Studies - CONy Pro/Con debate

Journal of Neural Transmission

, Volume 120, Issue 10, pp 1447-1451

First online:

Atrial fibrillation and stroke prevention: is warfarin still an option? Yes

Debate at the Controversies in Neurology congress, Beijing October 2011
  • J. David SpenceAffiliated withStroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, University of Western Ontario Email author 

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Abstract

With the advent of new oral anticoagulants, the place of warfarin for stroke prevention in patients with atrial fibrillation needs re-evaluation. Warfarin is difficult to use, because of large individual differences in response and metabolism, many significant interactions with drugs and foods, and fluctuations in vitamin K absorption. It requires frequent blood testing and dose adjustments, so with good reason patients and physicians are eager for the newer agents that are easier to use. However, the purchase price of the new anticoagulants is so high that warfarin will remain in widespread use. It is important therefore for physicians to know how to use it well. Anticoagulants work much better for stroke prevention in atrial fibrillation than do antiplatelet agents; physicians need to understand the concept of red thrombus (for which anticoagulants are required) versus white thrombus—platelet aggregates—which are the target of antiplatelet agents. Stroke from atrial fibrillation increases steeply with age, and the elderly benefit disproportionately from anticoagulation. It is still necessary for physicians to know how to use warfarin, and to use it better than it has been used in the past.

Keywords

Atrial fibrillation Stroke prevention Warfarin New oral anticoagulants Vitamin B12