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Stroke prevention in nonvalvular atrial fibrillation: a review of prospective randomized trials
G W Albers1, D G Sherman, D R Gress
1Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA 94305.
Insights
Warfarin significantly reduces stroke risk in atrial fibrillation patients, outweighing bleeding risks for most. Aspirin may suit low-risk patients or those unable to use anticoagulants.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Patients with atrial fibrillation face high risks of cerebral embolism.
- The efficacy of anticoagulation and antiplatelet therapies for stroke prevention in nonvalvular atrial fibrillation remains debated.
Purpose of the Study:
- To evaluate the risks and benefits of warfarin versus aspirin for stroke prevention in nonvalvular atrial fibrillation.
Main Methods:
- Analysis of three large prospective randomized trials comparing warfarin and aspirin therapies.
- Assessment of stroke rates and major bleeding incidence in treatment groups.
Main Results:
- Warfarin demonstrated a reduction in stroke rate across all three trials, with a low incidence of major bleeding.
- One study also reported a reduced stroke rate in patients treated with aspirin.
Conclusions:
- For most patients with nonvalvular atrial fibrillation, the benefits of warfarin in reducing thromboembolic events outweigh bleeding risks.
- Aspirin presents a viable alternative for specific patient subgroups, including those at low stroke risk or unsuitable for anticoagulation.
Abstract:
Patients with atrial fibrillation are at risk for cerebral embolism; however, the roles of chronic anticoagulation or antiplatelet therapy for stroke prevention in patients with nonvalvular atrial fibrillation have been controversial. Recently, the results of three large prospective randomized trials that examined the risks and benefits of warfarin or aspirin for stroke prophylaxis in patients with nonvalvular atrial fibrillation were reported. All three studies revealed a reduction in the stroke rate for patients treated with warfarin and a small incidence of major bleeding. One of the studies also reported a reduced stroke rate in aspirin-treated patients. The reduction of thromboembolic events associated with chronic warfarin therapy appears to outweigh the risks of significant bleeding for most patients with nonvalvular atrial fibrillation. Aspirin may offer an alternative for subgroups of patients who are at low risk for stroke or those who are not good candidates for anticoagulation.