Daniel E. Singer, MD
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Singer DE. Antithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation. Ann Intern Med. 2000;132:841. doi: 10.7326/0003-4819-132-10-200005160-00016
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Published: Ann Intern Med. 2000;132(10):841.
TO THE EDITOR:
I would like to note two methodologic caveats regarding Hart and colleagues' admirable systematic review (1). First, the authors describe the SPAF I (Stroke Prevention in Atrial Fibrillation Study), AFASAK (Copenhagen Atrial Fibrillation, Aspirin, and Anticoagulation Study), and EAFT (European Atrial Fibrillation Trial) as comparing anticoagulants to “placebo.” This is misleading. The placebo in these trials was an aspirin placebo (these trials also tested aspirin), not a warfarin placebo. None of the main potential benefits of using placebo (for example, reduced bias because of blinding) accrued to these trials' test of anticoagulants. In contrast, the SPINAF (Stroke Prevention in Nonrheumatic Atrial Fibrillation) trial was truly blinded. Blinding or no, the large effect of anticoagulation was seen across all the trials.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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