Warfarin therapy was significantly more common among persistent afibbers (87% were treated with warfarin) than among paroxysmal afibbers (25% were treated with warfarin). Warfarin therapy was underprescribed in patients with a CHADS2 score of 2 or greater and overprescribed for those with a CHADS2 score of 0. Thirty-five percent of patients with a zero score were still on warfarin at the end of the study period.
The GISSI investigators conclude that the incidence of TE and bleeding events was remarkably low in both paroxysmal and persistent AF despite a significant degree of over- or under-treatment with warfarin.Disertori, M, et al. Thromboembolic event rate in paroxysmal and persistent atrial fibrillation. BMC Cardiovascular Disorders, Vol. 13, 2013, pp. 28-37Reference 1Reference 2 Editor's comment
: This study adds to accumulating evidence that warfarin is often overprescribed and is not terribly effective except in the case of patients having suffered a previous stroke or TIA. It is also clear that the net benefit of warfarin therapy leaves much to be desired and is inappropriate in the case of lone afibbers with no risk factors for stroke[3,4].Reference 3Reference 4