Meta-analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation

Robert G. Hart, Lesly A. Pearce, Maria I. Aguilar

Research output: Contribution to journalArticle

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Abstract

Background: Atrial fibrillation is a strong independent risk factor for stroke. Purpose: 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. Data Sources: Randomized trials identified by using the Cochrane Stroke Group search strategy, 1966 to March 2007, unrestricted by language. Study Selection: 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. Data Extraction: Two coauthors independently extracted information regarding interventions; participants; and occurrences of ischemic and hemorrhagic stroke, major extracranial bleeding, and death. Data Synthesis: Twenty-nine trials included 28 044 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, 12 963 participants). Other randomized comparisons were inconclusive. Absolute increases in major extracranial hemorrhage were small (≤0.3% per year) on the basis of meta-analysis. Limitation: Methodological features and quality varied substantially and often were incompletely reported. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)857-867
Number of pages11
JournalAnnals of Internal Medicine
Volume146
Issue number12
StatePublished - Jun 5 2007

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Atrial Fibrillation
Meta-Analysis
Stroke
Warfarin
Fibrinolytic Agents
Platelet Aggregation Inhibitors
Therapeutics
Hemorrhage
Information Storage and Retrieval
Risk Reduction Behavior
Language
Safety

ASJC Scopus subject areas

  • Medicine(all)

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Meta-analysis : Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. / Hart, Robert G.; Pearce, Lesly A.; Aguilar, Maria I.

In: Annals of Internal Medicine, Vol. 146, No. 12, 05.06.2007, p. 857-867.

Research output: Contribution to journalArticle

Hart, Robert G. ; Pearce, Lesly A. ; Aguilar, Maria I. / Meta-analysis : Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. In: Annals of Internal Medicine. 2007 ; Vol. 146, No. 12. pp. 857-867.
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abstract = "Background: Atrial fibrillation is a strong independent risk factor for stroke. Purpose: 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. Data Sources: Randomized trials identified by using the Cochrane Stroke Group search strategy, 1966 to March 2007, unrestricted by language. Study Selection: 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. Data Extraction: Two coauthors independently extracted information regarding interventions; participants; and occurrences of ischemic and hemorrhagic stroke, major extracranial bleeding, and death. Data Synthesis: Twenty-nine trials included 28 044 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, 12 963 participants). Other randomized comparisons were inconclusive. Absolute increases in major extracranial hemorrhage were small (≤0.3{\%} per year) on the basis of meta-analysis. Limitation: Methodological features and quality varied substantially and often were incompletely reported. Conclusions: 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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