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5 October 1999 | Volume 131 Issue 7 | Pages 492-501
Purpose: To characterize the efficacy and safety of anticoagulants and antiplatelet agents for prevention of stroke in patients with atrial fibrillation.
Data Sources: Randomized trials identified by using the search strategy developed by the Cochrane Collaboration Stroke Review Group.
Study Selection: All published randomized trials testing antithrombotic agents to prevent stroke in patients with atrial fibrillation.
Data Extraction: Data on interventions, number of participants, duration of exposure and occurrence of all stroke (ischemic and hemorrhagic), major extracranial bleeding, and death were extracted independently by two investigators.
Data Synthesis: Sixteen trials included a total of 9874 participants (mean follow-up, 1.7 years). Adjusted-dose warfarin (six trials, 2900 participants) reduced stroke by 62% (95% CI, 48% to 72%); absolute risk reductions were 2.7% per year for primary prevention and 8.4% per year for secondary prevention. Major extracranial bleeding was increased by warfarin therapy (absolute risk increase, 0.3% per year). Aspirin (six trials, 3119 participants) reduced stroke by 22% (CI, 2% to 38%); absolute risk reductions were 1.5% per year for primary prevention and 2.5% per year for secondary prevention. Adjusted-dose warfarin (five trials, 2837 participants) was more efficacious than aspirin (relative risk reduction, 36% [CI, 14% to 52%]). Other randomized comparisons yielded inconclusive results.
Conclusions: Adjusted-dose warfarin and aspirin reduce stroke in patients with atrial fibrillation, and warfarin is substantially more efficacious than aspirin. The benefit of antithrombotic therapy was not offset by the occurrence of major hemorrhage among participants in randomized trials. Judicious use of antithrombotic therapy, tailored according to the inherent risk for stroke, importantly reduces stroke in patients with atrial fibrillation.
Author and Article Information
From University of Texas Health Science Center, San Antonio, Texas; and Axio Research Corp., Seattle, Washington.
Grant Support: By grant RO1 24224 from the National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland.
Requests for Reprints: Robert G. Hart, MD, Department of Medicine (Neurology), University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Drs. Hart and Benavente: Department of Medicine (Neurology), University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284.
Ms. McBride and Ms. Pearce: Axio Research Corp., 1107 NE 45th Street, Suite #520, Seattle, WA 98105. ARTICLE
Antithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation
A Meta-Analysis
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