The AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial enrolled 4060 patients with AFib to treatment with either cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm, or to use of heart rate-controlling drugs and allowing atrial fibrillation to persist.  The Figure highlights the use of warfarin vs no warfarin for the patients in the age range of 70–80 years, the age range when warfarin use was dropped in the previous Figure.  In these matched patients, use of warfarin as compared to no warfarin was associated with a lower mortality, a lower risk of ischemic stroke, a lower all-cause hospitalization, and lower major bleeding.  This emphasizes the important point that physicians must overcome this concern about older patients being at too high risk.  In fact, these older patients, increasingly presenting with AFib, are at too high risk not to be prescribed effective anticoagulation therapy.[90]

Reiffel JA. Am J MED 2013; 126: 00-00.