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(Stroke. 2008;39:e26.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Taggar et al

Lawrence Baruch, MD

Department of Medicine, Bronx Veterans Affairs Medical Center, Bronx, NY, Mount Sinai School of Medicine, New York, NY

Brian Gage, MD

Department of Medicine, Washington University, St. Louis, Mo

Jay Horrow, MD

Drexel University College of Medicine, Philadelphia, Pa

Response:

Thank you for your interest in our work. We agree with you that no model of stroke risk estimation is ideal. We also recognize the inadequacy of the schema with respect to the moderate risk patient whose management remains a clinical challenge. The focus of our article was on further risk stratifying those deemed at high stroke risk by recognized schema.¹

The BAFTA² findings have little implication for the high risk population. BAFTA by design targeted patients who were not at high risk of stroke because it was limited to patients for whom clinicians were uncertain as to the best treatment; this led to >20% of patients being excluded because it was determined that warfarin was the optimal treatment. Not surprisingly, this resulted in study population with a low prevalence of stroke risk factors.

The clinical implications of our findings, as highlighted in the Discussion section of our article, remain with the high risk population. More precise risk stratification of these patients may influence patient care with respect to usage of combination therapy, pharmacogenomic warfarin dosing, periprocedure anticoagulation strategies, and more vigorous anticoagulation management, as well as future clinical trial design.

Acknowledgments

Disclosures

None.

References

1. Baruch L, Gage BF, Horrow J, Juul-Moller S, Labovitz A, Persson M, Zabalgoitta M. Can patients at elevated risk of stroke treated with anticoagulants be further risk stratified? Stroke. 2007; 38: 2459–2463.[Abstract/Free Full Text]

2. Mant J, Hobbs R, Fletcher K, Roalfe A, Fitzmaurice D, Lip GYH, Murray E. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007; 370: 493–503.[CrossRef][Medline] [Order article via Infotrieve]

Related Article:

Can Patients With Atrial Fibrillation Be Optimally Risk Stratified for Stroke and Thromboembolism?

Jaspal S. Taggar, Timothy Watson, and Gregory Y.H. Lip
Stroke 2008 39: e24-e25. [Extract] [Full Text] [PDF]

This Article Extract Full Text (PDF) All Versions of this Article: 39/2/e26    most recent STROKEAHA.107.504191v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Baruch, L. Articles by Horrow, J. Search for Related Content PubMed Articles by Baruch, L. Articles by Horrow, J. Related Collections Related Article