WHY BE SO SPECIFIC ABOUT THE QUESTION? (continued)

This formulation would facilitatefinding an answer in the literature:

“Among female patients over age 65 with unstable gait and atrial fibrillation, would anticoagulation with warfarin, when compared with no anticoagulation, lead to lower mortality or morbidity from stroke? Does the benefit exceed the increased risk of CNS bleeding associated with a fall?”

• Starting with this question, we did a literature search and found a decision analysis.
• This study found that, all levels of fall risk, there was a clear advantage of anticoagulation (risk of stroke was high, and risk of CNS bleed from falls was much lower).
• ie., such patients should be given a trial of anticoagulation, regardless of fall risk.

Let’s look at the steps* in forming an answerable clinical question, then we can practice doing it...

*From: Evidence-based Medicine, Sackett et. al., 1998

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