In patients with non-valvular atrial fibrillation, aspirin did not reduce the incidence of ischemic stroke or systemic embolism compared to low-intensity anticoagulation (OR 0.94), but significantly increased all-cause mortality.
Meta-Analysis (n=963)
Open-label
Yes
Does aspirin reduce ischemic stroke or systemic embolism in patients with non-valvular atrial fibrillation compared to low-intensity anticoagulation?
In patients with non-valvular atrial fibrillation, aspirin provides no benefit over low-intensity anticoagulation for stroke prevention and is associated with increased all-cause mortality.
Effect estimate: OR 0.94 (95% CI 0.57-1.56)
BACKGROUND: Despite its lack of efficacy, aspirin is commonly used for stroke prevention in atrial fibrillation. Since prior studies have suggested a benefit of low-intensity anticoagulation over aspirin in the prevention of vascular events, the aim of this systematic review was to compare the outcomes of patients with non-valvular atrial fibrillation treated with low-intensity anticoagulation with Vitamin K antagonists or aspirin. METHODS: We conducted a systematic review searching Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials, from 1946 to October 14th, 2015. Randomized controlled trials were included if they reported the outcomes of patients with non-valvular atrial fibrillation treated with a low-intensity anticoagulation compared to patients treated with aspirin. The primary outcome was a combination of ischemic stroke or systemic embolism. The random-effects model odds ratio was used as the outcome measure. RESULTS: Our initial search identified 6309relevant articles of which three satisfied our inclusion criteria and were included. Compared to low-intensity anticoagulation, aspirin alone did not reduce the incidence of ischemic stroke or systemic embolism OR 0.94 (95% CI 0.57-1.56), major bleeding OR 1.06 (95% CI 0.42-2.62) or vascular death OR 1.04 (95% CI 0.61-1.75). The use of aspirin was associated with a significant increase in all-cause mortality OR 1.66 (95% CI 1.12-2.48). CONCLUSION: In patients with non-valvular atrial fibrillation, aspirin provides no benefits over low-intensity anticoagulation. Furthermore, the use of aspirin appears to be associated with an increased risk in all-cause mortality. Our study provides more evidence against the use aspirin in patients with non-valvular atrial fibrillation.
Vázquez et al. (2015) conducted a meta-analysis in Non-valvular atrial fibrillation (n=963). Aspirin vs. Low-intensity anticoagulation (Vitamin K antagonists) was evaluated on Combination of ischemic stroke or systemic embolism (OR 0.94, 95% CI 0.57-1.56). In patients with non-valvular atrial fibrillation, aspirin did not reduce the incidence of ischemic stroke or systemic embolism compared to low-intensity anticoagulation (OR 0.94), but significantly increased all-cause mortality.