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CMAJ • January 25, 2000; 162 (2)
© 2000 Canadian Medical Association or its licensors

Letters
Correspondance

Why aren't we falling for anticoagulant therapy?

Malcolm Man-Son-Hing

Geriatric medicine; University of Ottawa; Ottawa, Ont.

In his editorial regarding the reasons why so many eligible patients with atrial fibrillation are not receiving anticoagulant therapy,1 Stuart Connolly suggests that anticoagulant therapy is contraindicated in elderly patients with a history of falling. A recent study2 demonstrated that for the risks of anti-coagulation to outweigh its benefits, the average elderly person must fall approximately 300 times in 1 year; the study concluded that the risk of falling is not an important factor in the decision about whether to offer antithrombotic therapy to elderly people with atrial fibrillation.

Connolly focuses on patient factors involved in the lack of appropriate use of anticoagulants, but physician factors may be just as important. Treatment of patients with warfarin is a time-consuming, poorly remunerated aspect of clinical care, requiring multiple phone calls from the laboratory and contacts with the patient to explain dose adjustments. This may help to explain why physicians seek reasons (including a predisposition to falling) not to offer warfarin therapy to eligible patients. Before this care gap can be closed, both patient and physician factors need to be addressed.

References

  1. Connolly SJ. Preventing stroke in atrial fibrillation: Why are so many eligible patients not receiving anticoagulant therapy? [editorial]. CMAJ 1999;161(5):533-4.[Free Full Text]
  2. Man-Son-Hing M, Nichol G, Lau A, Laupacis A. Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. Arch Intern Med 1999;159:677-85.[Abstract/Free Full Text]




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