Adjusted-Dose Warfarin versus Aspirin for Preventing Stroke in Patients with Atrial Fibrillation

Abstract

Letters16 October 2007Adjusted-Dose Warfarin versus Aspirin for Preventing Stroke in Patients with Atrial FibrillationRobert G. Hart, MD, Lesly A. Pearce, MS, and Maria I. Aguilar, MDRobert G. Hart, MDFrom the University of Texas Health Science Center, San Antonio, TX 78229-3900; Minot, ND 58703; and Mayo Clinic Scottsdale, Phoenix, AZ 85054., Lesly A. Pearce, MSFrom the University of Texas Health Science Center, San Antonio, TX 78229-3900; Minot, ND 58703; and Mayo Clinic Scottsdale, Phoenix, AZ 85054., and Maria I. Aguilar, MDFrom the University of Texas Health Science Center, San Antonio, TX 78229-3900; Minot, ND 58703; and Mayo Clinic Scottsdale, Phoenix, AZ 85054.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-147-8-200710160-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The recently published, randomized Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) Study compared adjusted-dose warfarin (target international normalized ratio, 2.0 to 3.0) with aspirin (75 mg/d) in 973 patients with atrial fibrillation who were 75 years of age or older (mean age, 81.5 years) and were managed by general practitioners in the United Kingdom (1). The study's important results indicate that the relative efficacy and safety of warfarin for stroke prevention can be extended to very elderly patients who are managed by nonspecialists. Because the BAFTA Study seems likely to be the last large trial comparing ...References1. Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007;370:493-503. [PMID: 17693178] CrossrefMedlineGoogle Scholar2. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146:857-67. [PMID: 17577005] LinkGoogle Scholar3. Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet. 1989;1:175-9. [PMID: 2563096] CrossrefMedlineGoogle Scholar4. Petersen P, Boysen G. Prevention of stroke in atrial fibrillation. N Engl J Med. 1990;323:482. Google Scholar5. Gulløv AL, Koefoed BG, Petersen P, Pedersen TS, Andersen ED, Godtfredsen J, et al. Fixed minidose warfarin and aspirin alone and in combination vs adjusted-dose warfarin for stroke prevention in atrial fibrillation: Second Copenhagen Atrial Fibrillation, Aspirin, and Anticoagulation Study. Arch Intern Med. 1998;158:1513-21. [PMID: 9679792] CrossrefMedlineGoogle Scholar6. Antithrombotic Therapy in Atrial Fibrillation Study Group. [The randomized study of efficiency and safety of antithrombotic therapy in nonvalvular atrial fibrillation: warfarin compared with aspirin]. Zhonghua Xin Xue Guan Bing Za Zhi. 2006;34:295-8. [PMID: 16776915] MedlineGoogle Scholar7. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet. 1993;342:1255-62. [PMID: 7901582] CrossrefMedlineGoogle Scholar8. Hellemons BS, Langenberg M, Lodder J, Vermeer F, Schouten HJ, Lemmens T, et al. Primary prevention of arterial thromboembolism in non-rheumatic atrial fibrillation in primary care: randomised controlled trial comparing two intensities of coumarin with aspirin. BMJ. 1999;319:958-64. [PMID: 10514159] CrossrefMedlineGoogle Scholar9. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet. 1994;343:687-91. [PMID: 7907677] MedlineGoogle Scholar10. Morocutti C, Amabile G, Fattapposta F, Nicolosi A, Matteoli S, Trappolini M, et al. Indobufen versus warfarin in the secondary prevention of major vascular events in nonrheumatic atrial fibrillation. SIFA (Studio Italiano Fibrillazione Atriale) Investigators. Stroke. 1997;28:1015-21. [PMID: 9158644] CrossrefMedlineGoogle Scholar11. ACTIVE Writing Group on behalf of the ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet. 2006;367:1903-12. [PMID: 16765759] CrossrefMedlineGoogle Scholar12. NASPEAF Investigators. Comparative effects of antiplatelet, anticoagulant, or combined therapy in patients with valvular and nonvalvular atrial fibrillation: a randomized multicenter study. J Am Coll Cardiol. 2004;44:1557-66. [PMID: 15489085] CrossrefMedlineGoogle Scholar13. Vemmos KN, Tsivgoulis G, Spengos K, Manios E, Xin