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Antithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation: A Meta-Analysis

Robert G. Hart, MD; Oscar Benavente, MD; Ruth McBride, BS; and Lesly A. Pearce, MS
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From University of Texas Health Science Center, San Antonio, Texas; and Axio Research Corp., Seattle, Washington.


Grant Support: By grant RO1 24224 from the National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland.

Requests for Reprints: Robert G. Hart, MD, Department of Medicine (Neurology), University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Hart and Benavente: Department of Medicine (Neurology), University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284.

Ms. McBride and Ms. Pearce: Axio Research Corp., 1107 NE 45th Street, Suite #520, Seattle, WA 98105.


Ann Intern Med. 1999;131(7):492-501. doi:10.7326/0003-4819-131-7-199910050-00003
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Nonvalvular atrial fibrillation is an important independent risk factor for stroke. Since 1989, 16 published clinical trials have conducted 36 separate randomized comparisons of antithrombotic agents in approximately 10 000 participants with atrial fibrillation (117). Previously published meta-analyses and pooled analyses of individual patient data (1820) have considered, in various combinations, the first 6 clinical trials to be published. We present a meta-analysis of all currently available trials to further characterize the comparative efficacy and safety of antithrombotic therapy for the prevention of stroke in patients with atrial fibrillation.

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Figure.
Effects on all stroke (ischemic and hemorrhagic) of therapies for patients with atrial fibrillation. Top.Middle.Bottom.

Adjusted-dose warfarin compared with placebo (six randomized trials). Aspirin compared with placebo (six randomized trials). Adjusted-dose warfarin compared with aspirin (five randomized trials). Horizontal lines are 95% CIs around the point estimates. AFASAK = Copenhagen Atrial Fibrillation, Aspirin, and Anticoagulation Study; BAATAF = Boston Area Anticoagulation Trial for Atrial Fibrillation; CAFA = Canadian Atrial Fibrillation Anticoagulation Study; EAFT = European Atrial Fibrillation Trial; ESPS II = European Stroke Prevention Study II; LASAF = Low-Dose Aspirin, Stroke, and Atrial Fibrillation Pilot Study; PATAF = Prevention of Arterial Thromboembolism in Atrial Fibrillation; SPAF = Stroke Prevention in Atrial Fibrillation Study; SPINAF = Stroke Prevention in Nonrheumatic Atrial Fibrillation; UK-TIA = United Kingdom TIA Study.

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Summary for Patients

Therapy to Prevent Stroke in Patients with Atrial Fibrillation

The summary below is from the full report titled “Antithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation: A Meta-Analysis.” It is in the 5 October 1999 issue of Annals of Internal Medicine (volume 131, pages 492-501). The authors are R.G. Hart, O. Benavente, R. McBride, and L.A. Pearce.

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