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Warfarin reduces silent cerebral infarction in elderly patients with atrial fibrillation
S Matsuo1, Y Nakamura, M Kinoshita
1First Department of Internal Medicine, Shiga University of Medical Science, Japan. matsuo@suncuore.shiga-med.ac.jp
Insights
Warfarin treatment significantly reduced the progression of silent cerebral infarction in patients with atrial fibrillation over one year. This anticoagulant therapy shows promise in preventing brain lesions in this patient group.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Atrial fibrillation is a known risk factor for silent cerebral infarction.
- The Shiga Atrial Fibrillation Trial investigated this link across five medical centers.
Purpose of the Study:
- To test if warfarin can prevent silent cerebral infarction in patients diagnosed with atrial fibrillation.
Main Methods:
- 15 asymptomatic atrial fibrillation patients underwent MRI at study entry and after 1 year.
- Hyperintensities on T2-weighted MRI were scored in periventricular and centrum semiovale areas.
- Patients were randomized to receive warfarin or not.
Main Results:
- Silent cerebral infarction was prevalent, seen in 93% of patients.
- Brain lesions increased significantly over one year (P < 0.01).
- Warfarin-treated patients showed a significantly smaller increase in lesion scores (P < 0.05).
Conclusions:
- Anticoagulation therapy, specifically warfarin, is effective in preventing silent cerebral infarction.
- This preventative strategy is beneficial for neurologically normal elderly patients with atrial fibrillation.
Background:
Atrial fibrillation is reportedly one of the risk factors of silent cerebral infarction. The Shiga Atrial Fibrillation Trial was conducted in five medical centers, to test the hypothesis that warfarin can prevent silent cerebral infarction in patients with atrial fibrillation.
Methods:
Magnetic resonance images (MRI) were taken at the time of the patient's entry to the study and 1 year later in 15 asymptomatic patients (74 +/- 4 years old) with atrial fibrillation who were randomly allocated to two treatment groups to receive or not receive warfarin. The frequency of hyperintensities on T2-weighted axis MRI was rated using a four-point scale in the periventricular and centrum semiovale areas. Total silent cerebral infarction scores were calculated at the sum of the scores on MRI.
Results:
Silent cerebral infarction was seen in 14 (93%) of the 15 patients with atrial fibrillation and a total of 109 silent cerebral infarction lesions were detected. The number of hyperintensities in the periventricular and centrum semiovale areas increased over the 1 year of study (P < 0.01). The increase in total score over 1 year was less in the warfarin-treated group (1.6 +/- 0.7 compared with 5.4 +/- 0.9, P < 0.05).
Conclusion:
Anticoagulation therapy can be useful to prevent silent cerebral infarction in neurologically normal elderly patients with atrial fibrillation.