Abstract
OBJECTIVE: To review the evidence for antithrombotic therapy in patients with nonrheumatic atrial fibrillation. QUALITY OF EVIDENCE: Five primary prevention trials and one secondary prevention trial compare antithrombotic therapy with placebo or no treatment. Two trials also determine the efficacy and safety of acetylsalicylic acid. MAIN FINDINGS: Warfarin reduces the risk of stroke by 68%. The effect is consistent in all identifiable groups of patients with nonrheumatic atrial fibrillation, except patients at serious risk of hemorrhage. The absolute benefit of anticoagulants varies among patients because of markedly different inherent risk of stroke among patient subgroups. CONCLUSIONS: Anticoagulant therapy should be considered for all patients with atrial fibrillation. Oral anticoagulant therapy is more effective than ASA in reducing the risk of stroke among patients with nonrheumatic atrial fibrillation.
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Selected References
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- Connolly S. J., Laupacis A., Gent M., Roberts R. S., Cairns J. A., Joyner C. Canadian Atrial Fibrillation Anticoagulation (CAFA) Study. J Am Coll Cardiol. 1991 Aug;18(2):349–355. doi: 10.1016/0735-1097(91)90585-w. [DOI] [PubMed] [Google Scholar]
- Ezekowitz M. D., Bridgers S. L., James K. E., Carliner N. H., Colling C. L., Gornick C. C., Krause-Steinrauf H., Kurtzke J. F., Nazarian S. M., Radford M. J. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. N Engl J Med. 1992 Nov 12;327(20):1406–1412. doi: 10.1056/NEJM199211123272002. [DOI] [PubMed] [Google Scholar]
- Hull R., Hirsh J., Jay R., Carter C., England C., Gent M., Turpie A. G., McLoughlin D., Dodd P., Thomas M. Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Engl J Med. 1982 Dec 30;307(27):1676–1681. doi: 10.1056/NEJM198212303072704. [DOI] [PubMed] [Google Scholar]
- Landefeld C. S., Beyth R. J. Anticoagulant-related bleeding: clinical epidemiology, prediction, and prevention. Am J Med. 1993 Sep;95(3):315–328. doi: 10.1016/0002-9343(93)90285-w. [DOI] [PubMed] [Google Scholar]
- Landefeld C. S., Goldman L. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med. 1989 Aug;87(2):144–152. doi: 10.1016/s0002-9343(89)80689-8. [DOI] [PubMed] [Google Scholar]
- Levine M. N., Raskob G., Landefeld S., Hirsh J. Hemorrhagic complications of anticoagulant treatment. Chest. 1995 Oct;108(4 Suppl):276S–290S. doi: 10.1378/chest.108.4_supplement.276s. [DOI] [PubMed] [Google Scholar]
- Turpie A. G., Gunstensen J., Hirsh J., Nelson H., Gent M. Randomised comparison of two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet. 1988 Jun 4;1(8597):1242–1245. doi: 10.1016/s0140-6736(88)92070-3. [DOI] [PubMed] [Google Scholar]
- Wolf P. A., Abbott R. D., Kannel W. B. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991 Aug;22(8):983–988. doi: 10.1161/01.str.22.8.983. [DOI] [PubMed] [Google Scholar]