Response to Letter by Taggar et al
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.
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.
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.