Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attacks.
BACKGROUND
People with nonrheumatic atrial fibrillation who have had a transient ischemic attack or a minor ischemic stroke are at risk of recurrent stroke.


OBJECTIVE
The objective of this review was to assess the effect of anticoagulants for secondary prevention, after a stroke or transient ischaemic attack, in patients with nonrheumatic atrial fibrillation.


METHODS
The reviewer searched the Cochrane Stroke Group trials register and contacted trialists.


METHODS
Randomised trials comparing oral anticoagulants (target International Normalised Ratio range 2.5 to 4.0) with control or placebo in people with nonrheumatic atrial fibrillation and a previous transient ischaemic attack or minor ischaemic stroke.


METHODS
One reviewer assessed trial quality and extracted data.


RESULTS
Two trials involving 485 people were included. Anticoagulants reduced the risk of recurrent stroke by two-thirds (odds ratio 0.36, 95% confidence interval 0.22 to 0.58). The risk of all vascular events was shown to be almost halved by treatment (odds ratio 0.55, 95% confidence interval 0.37 to 0.82). No intracranial bleeds were reported among people given anticoagulants.


CONCLUSIONS
The evidence suggests that anticoagulants are beneficial, without serious adverse effects, for people with nonrheumatic atrial fibrillation and recent cerebral ischaemia.
Koudstaal
P J
PJ
Department of Neurology, University Hospital Rotterdam, 40 Dr Molewaterplein, Rotterdam, Netherlands, 3015 GD. koudstaal@neur.azr.nl
D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000517:prevention & control*; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control*
D000925:Anticoagulants