[Choice of antithrombotic therapy in atrial fibrillation, a daily challenge. No convincing evidence that warfarin is better than acetylsalicylic acid].
Current guidelines relating to the primary prevention of stroke in non-valvular atrial fibrillation are primarily based on randomised trials comparing warfarin with placebo. Warfarin is recommended in the majority of patients. However, weaknesses in the design and performance of these trials tend to overestimate the treatment effect. Furthermore, the inclusion of highly selected patients with a low percentage of elderly subjects, low bleeding risk, short follow-up periods and high discontinuation rates makes it impossible to generalize the results and apply them to general practice. Trials directly comparing warfarin with aspirin are the most reliable when it comes to comparing treatment efficacy. These trials have included a similar number of patients but a larger percentage of elderly patients and they comprise more years of observation and end-point events compared with the placebo-controlled warfarin trials. The results show that warfarin is not convincingly superior to aspirin in terms of stroke prevention. Warfarin can only be recommended in patients with a high risk of thromboembolic events.
Mooe
Thomas
T
Department of Internal Medicine, Ostersunds sjukhus, SE-83183 Ostersund, Sweden. thomas.mooe@medicin.umu.se
D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D001241:Aspirin
Val av antitrombotisk behandling vid förmaksflimmer, ett dagligt huvudbry. Ingen övertygande evidens för att warfarin är bättre än acetylsalicylsyra.