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The Figure interprets data from 2 studies [88][89] showing the expected dramatic increase in strokes per 1000 patient-years with increasing age. Intersecting that upward sloping line, however, is the decreasing slope for percent use of warfarin with increasing age. In other words, the gap between risk for stroke dramatically increases with age, and the use of anticoagulation falls with age, resulting in marked under treatment for precisely the population with the highest risk. This illustrates how physicians are often hesitant to anticoagulate older patients – perhaps because of concerns about their falling and bleeding – and yet these patients are the ones who need it the most.
Reiffel JA. Am J MED 2013; 126: 00-00.
[88] White RH, McBurnie MA, Manolio T, et al. Oral anticoagulation in patients with atrial fibrillation: adherence with guidelines in an elderly cohort. Am J Med. 1999;106:165-171.
[89] Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987;147:1561-1564.