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- Publisher
- American Medical Association
- Copyright
- Copyright © 1994 American Medical Association. All Rights Reserved.
- ISSN
- 0003-9926
- eISSN
- 1538-3679
- DOI
- 10.1001/archinte.1994.00420130030006
- Publisher site
- See Article on Publisher Site
Abstract
Abstract There new studies help clarify important clinical issues regarding antithrombotic therapy for stroke prevention in patients with atrial fibrillation. The European Atrial Fibrillation Trial compared the efficacy of oral anticoagulation, aspirin, and placebo for stroke prevention in patients with atrial fibrillation with a recent stroke or transient ischemic attack. The results of the Stroke Prevention in Atrial Fibrillation II trial, which compared the efficacy of warfarin and aspirin, provide new information regarding the risk of intracranial hemorrhage in elderly patients with atrial fibrillation. Finally, an analysis of pooled data from the first five randomized trials identified clinical features that are predictive of stroke risk in individual patients with atrial fibrillation. These studies address unanswered questions regarding atrial fibrillation and stroke and have significant implications for patient management. (Arch Intern Med. 1994;154:1443-1448) References 1. Petersen P, Godtfredsen J, Boysen G, Andersen ED, Andersen B. Placebo-controlled, randomized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: The Copenhagen AFASAK study . Lancet . 1989;1:175-179.Crossref 2. The Stroke Prevention in Atrial Fibrillation Investigators. The stroke prevention in atrial fibrillation study: final results . Circulation . 1991;84: 527-539.Crossref 3. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation . N Engl J Med . 1990; 323:1505-1511.Crossref 4. Connolly S, Laupacis A, Gent M. Canadian atrial fibrillation anticoagulation (CAFA) study . J Am Coll Cardiol . 1991;18:349-355. 5. Ezekowitz M, Bridgers S, James K, et al. VA cooperative study of warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation . N Engl J Med . 1992;327:1406-1412.Crossref 6. Albers GW, Sherman DG, Gress DR, Paulseth JE, Petersen P. Stroke prevention in nonvalvular atrial fibrillation: a review of prospective randomized trials . Ann Neurol . 1991;30:511-518.Crossref 7. Atwood J, Albers G. Anticoagulation and atrial fibrillation . Herz . 1993;18:27-38. 8. Laupacis A, Albers G, Dunn M, Feinberg W. Antithrombotic therapy in atrial fibrillation . Chest . 1992;102( (suppl) ):426S-433S.Crossref 9. Stroke Prevention in Atrial Fibrillation Investigators. A differential effect of aspirin on prevention of stroke in atrial fibrillation . J Stroke Cerebrovasc Dis . 1993;3:181-188. 10. Philips S. Whisnant J, O'Fallon W, Frye R. Prevalence of cardiovascular disease and diabetes in residents of Rochester, Minnesota . Mayo Clin Proc . 1990;65:344-359.Crossref 11. Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials . Arch Intern Med . 1994;154:1449-1457.Crossref 12. European Atrial Fibrillation Trial Study Group. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke . Lancet . 1993;342:1255-1262. 13. Stroke Prevention in Atrial Fibrillation Investigators. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study . Lancet . 1994; 343:687-691. 14. Antiplatelet Trialists' Collaboration. I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients . BMJ . 1994:308: 81-106.Crossref 15. Yatsu FM, Hart RG, Mohr JP, Grotta JC. Anticoagulation of embolic strokes of cardiac origin: an update . Neurology . 1988;38:314-316.Crossref 16. Sherman DG, Dyken ML, Fisher M, Gent M, Harrison MJG, Hart RG. Antithrombotic therapy for cerebrovascular disorders . Chest . 1992;102 ( (suppl) ):529S-537S.Crossref 17. The Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation, II: echocardiographic features of patients at risk . Ann Intern Med . 1992;116: 6-12.Crossref 18. Kase CS, Robinson RK, Stein RW, et al. Anticoagulant-related intracerebral hemorrhage . Neurology . 1985;35:943-948.Crossref 19. Wintzen AR, deJonge H, Loeliger EA, Bots GTAM. The risk of intracerebral hemorrhage during oral anticoagulant treatment: a population study . Ann Neurol . 1984;16:553-558.Crossref 20. Albers GW. Intensity of anticoagulant treatment and risk of intracerebral hematoma . Stroke . 1990; 21:1758.Crossref 21. Levine M, Hirsh J, Landefled S, Raskob G. Hemorrhagic complications of anticoagulant treatment . Chest . 1992;102( (suppl) ):352S-363S.Crossref 22. Kelton J, Hirsh J. Bleeding associated with antithrombotic therapy . Semin Hematol . 1980:17: 259-291. 23. The Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation, I: clinical features of patients at risk . Ann Intern Med . 1992;116:1-5.Crossref
Journal
Archives of Internal Medicine – American Medical Association
Published: Jul 11, 1994