When the elderly need a protection order against warfarin-wielding physicians

This is a tree.  If you want to see the forest, back up.

(Added 1/11/12 - This post was prescient:  See this article in today's NYT: Interactive Tools to Assess the Likelihood of Death which reviews this JAMA article: Prognostic Indices for Older Adults; here is the Prognosis Website - In my opinion, it's too complicated to be useful, but it's a start.)

Ever since I was in medical school, I have been hearing the tired old refrain about how warfarin for stroke prevention in atrial fibrillation is underutilized in just about everybody, especially the elderly.  Well, if you want to see uber-high rates of warfarin underutilization, you need look no further than trials of stroke prevention such as the original SPAF trial (Ezekowitz, NEJM, 1992), where more than 93% of screened patients were excluded from the trial and not given warfarin!  There's an interesting contradiction.  Moreover, it is likely that warfarin is not as underutilized as has been stated because of inadequate data on appropriate exclusion criteria (see Srivastava, Thrombosis Journal, 2008).