Robert G. Hart, MD; Lesly A. Pearce, MS; Maria I. Aguilar, MD
Atrial fibrillation is a strong independent risk factor for stroke.
To characterize the efficacy and safety of antithrombotic agents for stroke prevention in patients who have atrial fibrillation, adding 13 recent randomized trials to a previous meta-analysis.
Randomized trials identified by using the Cochrane Stroke Group search strategy, 1966 to March 2007, unrestricted by language.
All published randomized trials with a mean follow-up of 3 months or longer that tested antithrombotic agents in patients who have nonvalvular atrial fibrillation.
Two coauthors independently extracted information regarding interventions; participants; and occurrences of ischemic and hemorrhagic stroke, major extracranial bleeding, and death.
Twenty-nine trials included 28Â 044 participants (mean age, 71 years; mean follow-up, 1.5 years). Compared with the control, adjusted-dose warfarin (6 trials, 2900 participants) and antiplatelet agents (8 trials, 4876 participants) reduced stroke by 64% (95% CI, 49% to 74%) and 22% (CI, 6% to 35%), respectively. Adjusted-dose warfarin was substantially more efficacious than antiplatelet therapy (relative risk reduction, 39% [CI, 22% to 52%]) (12 trials, 12Â 963 participants). Other randomized comparisons were inconclusive. Absolute increases in major extracranial hemorrhage were small (â‰¤0.3% per year) on the basis of meta-analysis.
Methodological features and quality varied substantially and often were incompletely reported.
Adjusted-dose warfarin and antiplatelet agents reduce stroke by approximately 60% and by approximately 20%, respectively, in patients who have atrial fibrillation. Warfarin is substantially more efficacious (by approximately 40%) than antiplatelet therapy. Absolute increases in major extracranial hemorrhage associated with antithrombotic therapy in participants from the trials included in this meta-analysis were less than the absolute reductions in stroke. Judicious use of antithrombotic therapy importantly reduces stroke for most patients who have atrial fibrillation.
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Hart RG, Pearce LA, Aguilar MI. Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation. Ann Intern Med. 2007;146:857-867. doi: 10.7326/0003-4819-146-12-200706190-00007
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Published: Ann Intern Med. 2007;146(12):857-867.
Cardiology, Neurology, Prevention/Screening, Rhythm Disorders and Devices, Stroke.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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