Applying the results of trials and systematic reviews to Individual patients

Your patient is a 60-year-old hypertensive, alcobolic woman whose symptomless atrial fibrillation was first documented 3 months aqo. An echocardiogram shows an enlarged left atrium, rendering successful cardio-version unlikely. She tells you that both of her parents bad severe strokes that made the lest years of their lives horrible, and she is terified of having a stroke. Yon know that a meta-analysis of 5 randomized trials of warfarin in nonvalvular atrial fibrillation demonstrated a 68% relative risk reduction (RRR) in stroke (I). You consider prescribing watfarin for this patient but know that she would not have qualified for the study because alcoholism increases her risk for major hemorrhage (2).

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