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Warfarin or aspirin for non-rheumatic atrial fibrillation?
Insights
Atrial fibrillation (AF) increases stroke risk. This review examines if warfarin or aspirin therapy is best for non-rheumatic AF patients, based on recent trials.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Atrial fibrillation (AF) is a known risk factor for stroke.
- Stroke risk is elevated in AF patients with comorbidities like rheumatic heart disease, heart failure, hypertension, diabetes, or thyrotoxicosis.
- Current guidelines for anticoagulation in rheumatic AF are based on tradition rather than randomized trials.
Purpose of the Study:
- To review evidence from randomized controlled trials on anticoagulation for non-rheumatic AF.
- To determine if warfarin or aspirin therapy should be standard for non-rheumatic AF patients.
Main Methods:
- Review of recent randomized controlled trials (RCTs).
- Analysis of evidence regarding anticoagulation with warfarin versus antiplatelet therapy with aspirin.
Main Results:
- Evidence synthesis from recent RCTs on stroke prevention in non-rheumatic AF.
- Comparison of efficacy and safety of warfarin and aspirin in this patient group.
Conclusions:
- The review informs clinical decisions on stroke prevention in non-rheumatic AF.
- Recommendations on routine anticoagulation or antiplatelet therapy for non-rheumatic AF patients.
Abstract:
Atrial fibrillation (AF) predisposes to stroke, particularly in patients with rheumatic heart disease, congestive heart failure, arterial hypertension, diabetes mellitus or uncontrolled thyrotoxicosis. In those with rheumatic heart disease it is usual to give warfarin to reduce the incidence of stroke, although there has been no randomised controlled trial on which to base this approach. Whether patients with non-rheumatic AF should be anticoagulated was unclear when we tackled this subject five years ago. This article reviews the evidence from recent randomised controlled trials and considers whether anticoagulation with warfarin, or antiplatelet therapy with aspirin, should now be routine for patients with non-rheumatic AF.