Robert G. Hart, MD; Lesly A. Pearce, MS
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Hart R., Pearce L.; Antithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation. Ann Intern Med. 2000;132:841-842. doi: 10.7326/0003-4819-132-10-200005160-00017
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Published: Ann Intern Med. 2000;132(10):841-842.
Thanks to Dr. Singer for pointing out a misleading heading in Table 2 of our meta-analysis: “Control group” was inadvertently changed to “placebo group” in the process of revision.
Dr. Singer's lack of enthusiasm for aspirin use in atrial fibrillation is long-standing and often voiced (1, 2). His current concerns appear based on post hoc exploratory subgroup analyses of SPAF I, which are not relevant to our meta-analysis. To date, all six randomized trials (five of them double-blind) have shown trends toward reduction in stroke with aspirin use in patients with atrial fibrillation (see the Figure in our meta-analysis). Furthermore, randomized trials comparing warfarin with aspirin have consistently shown a smaller magnitude of stroke reduction than seen in trials comparing warfarin with control or placebo. In short, it seems overwhelmingly likely that aspirin provides some protection against stroke in atrial fibrillation, but the efficacy is clearly much less than that provided by adjusted-dose warfarin, particularly when considering disabling cardioembolic strokes.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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