Key result
Oral anticoagulants did not significantly reduce the overall rate of stroke compared to aspirin in patients with atrial fibrillation (OR 0.667), but significantly reduced stroke risk in the nonrheumatic subgroup.
Why the study?
Does adjusted-dose warfarin reduce stroke and systemic embolism compared to aspirin in patients with atrial fibrillation?
Population
4,363 patients with atrial fibrillation from 8 randomized controlled trials, majority >70 years of age.
Comparison
Adjusted-dose warfarin titrated to an… vs Aspirin administered at a dosage of 75 to 325 mg/d
Design
Meta-analysis
Authors
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Does not support oral anticoagulants over aspirin for overall stroke prevention in atrial fibrillation; challenges broad use while extending benefit to nonrheumatic subgroups.
Meta-Analysis (n=4,363)
Does adjusted-dose warfarin reduce stroke and systemic embolism compared to aspirin in patients with atrial fibrillation?
Effect estimate: OR 0.667 (95% CI 0.426-1.045)
Absolute Event Rate: 90% vs 136%
p-value: p=0.08
In patients with atrial fibrillation, adjusted-dose warfarin reduces the risk of systemic embolism compared to aspirin without significantly increasing the risk of major bleeding.
Zhang et al. (2015) conducted a meta-analysis in Atrial Fibrillation (n=4,363). Oral Anticoagulants (warfarin or coumarin) vs. Aspirin (75 to 325 mg/d) was evaluated on Rate of stroke (OR 0.667, 95% CI 0.426-1.045, p=0.08). Oral anticoagulants did not significantly reduce the overall rate of stroke compared to aspirin in patients with atrial fibrillation (OR 0.667), but significantly reduced stroke risk in the nonrheumatic subgroup.
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