Aspirin prophylaxis reduced the occurrence of noncardioembolic strokes significantly more than cardioembolic strokes in patients with nonrheumatic atrial fibrillation (p=0.01).
Observational (n=71)
Blinded to treatment assignment
Does aspirin prophylaxis have a differential effect on cardioembolic versus noncardioembolic ischemic strokes in patients with nonrheumatic atrial fibrillation?
In patients with nonrheumatic atrial fibrillation, ischemic strokes have diverse mechanisms, and aspirin prophylaxis appears significantly more effective at preventing noncardioembolic strokes than cardioembolic ones.
p-value: p=0.01
Ischemic strokes occurring in patients with nonrheumatic atrial fibrillation are due to a variety of mechanisms, not exclusively to cardiogenic embolism. Without knowledge of antithrombotic therapy assignment, we categorized strokes in the Stroke Prevention in Atrial Fibrillation Study as presumed cardioembolic or noncardioembolic. We then compared patient clinical and echocardiographic variables, as well as the efficacy of aspirin prophylaxis, for each stroke type. Of 71 ischemic strokes, we categorized 46 (65%) as cardioembolic, 13 (18%) as noncardioembolic, and 12 (17%) as of uncertain cause. Patients developing noncardioembolic strokes, relative to cardioembolic strokes, were more commonly men (p = 0.005) and were more likely to have left ventricular wall motion abnormalities by two-dimensional echocardiography (p = 0.002). Aspirin reduced the occurrence of strokes categorized as noncardioembolic significantly more than it did those categorized as cardioembolic (p = 0.01). These results emphasize the value of considering stroke mechanisms in therapeutic trials of antithrombotic agents and suggest a differential effect of aspirin according to mechanism.
Miller et al. (Fri,) conducted a observational in Nonrheumatic atrial fibrillation (n=71). Aspirin prophylaxis was evaluated on Differential reduction in occurrence of noncardioembolic versus cardioembolic strokes (p=0.01). Aspirin prophylaxis reduced the occurrence of noncardioembolic strokes significantly more than cardioembolic strokes in patients with nonrheumatic atrial fibrillation (p=0.01).