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Most patients with atrial fibrillation (AF) are older than 75. Clinical guidelines call for anticoagulation in these patients, although they are perceived to have increased risk for hemorrhage and are underrepresented in clinical trials.
In this randomized trial, 973 patients (age ≥75) with atrial fibrillation or flutter were recruited from primary care practices in the U.K.; they received warfarin (titrated to an INR of 2–3) or aspirin (75 mg daily). After an average 2.7 years of follow-up, patients who received warfarin had significantly fewer fatal or disabling strokes, other intracranial hemorrhages, or clinically significant arterial emboli than those who received aspirin (1.8% vs. 3.8% per year). Warfarin was as effective in people old…