October 1, 1991
View Full PaperStroke prevention in nonvalvular atrial fibrillation: A review of prospective randomized trials
Key Result
Chronic warfarin therapy reduces the stroke rate in patients with nonvalvular atrial fibrillation, with benefits appearing to outweigh the risks of significant bleeding for most patients.
Structured PICO
Does warfarin or aspirin reduce stroke rate in patients with nonvalvular atrial fibrillation?
P
Population
Patients with nonvalvular atrial fibrillation (review of 3 large prospective randomized trials)
I
Intervention
Warfarin or aspirin (chronic anticoagulation or antiplatelet therapy)
O
Outcome
Stroke ratehard clinical
Chronic warfarin therapy reduces thromboembolic events in most patients with nonvalvular atrial fibrillation, outweighing bleeding risks, while aspirin offers an alternative for low-risk or anticoagulation-ineligible patients.
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.