What Are the Main Results of Large Trials of Secondary Prevention Comparing Oral Anticoagulation in Atrial Fibrillation and Aspirin?
Antiplatelet therapy may be an alternative for secondary prevention of stroke and other serious vascular events in patients with atrial fibrillation. The comparison of aspirin- and placebo-treated patients in the combined groups (anticoagulation eligible and ineligible) show an event rate of 19% in the placebo and 15% in the aspirin-assigned patients. There is a 60% risk reduction favouring warfarin compared with aspirin. Moreover, the high stroke rate in the EAFT is consistent with the observation in the other randomized trials that prior stroke or transient ischemic attack is an important predictor of increased stroke risk in patients with atrial fibrillation. * Although aspirin appears to be less effective, it is safer and less expensive than oral anticoagulants. Moreover, both the targeted and the actual levels of anticoagulant control have differed widely among the studies. Additional efficacy analyses are required to determine which intensity of oral anticoagulant treatment in no
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