European Atrial Fibrillation Trial - EAFT
Warfarin vs. aspirin for ischemic stroke in atrial fibrillation.
Anticoagulation or aspirin may provide a preventive benefit for patients with a recent transient ischemic attack (TIA) or minor ischemic stroke.
Patients Screened: Not given
Patients Enrolled: 1,007
Mean Follow Up: 2.3 years
> Age 25 years
Recent TIA or minor ischemic stroke in previous 3 months
Atrial fibrillation proven electrocardiographically at time of stroke or TIA; or, in paroxysmal atrial fibrillation, in the preceding 24 months
Rheumatic valvular disease.
Atrial fibrillation secondary to other disorders.
Taking non-steroidal anti-inflammatory drugs, other anti-platelet-aggregating drugs, or oral anticoagulants.
Other sources of cardiac emboli, such as prosthetic valves, cardiac aneurysm, atrial myxoma, cardiothoracic ratio exceeding 0.65%, myocardial infarction (MI) in the preceding 3 months, or disorders of blood coagulation.
Scheduled for carotid endarterectomy or coronary surgery within the next 3 months.
Death from vascular disease
Non-fatal stroke, including intracranial hemorrhage
Death from all causes
All strokes, fatal or non-fatal
Major thromboembolic events (vascular death, major stroke, major systemic embolism, or MI)
Oral anticoagulants to achieve a therapeutic international normalized ratio range of 2.5-4.0 (aim 3.0).
Aspirin, 300 mg/day.
Patients with contraindications to anticoagulants were randomized to aspirin or placebo.
Annual rate of outcome events was 8% of patients on anticoagulants, vs. 17% on placebo in group 1 (patients eligible for anticoagulants) (hazard ratio [HR] of 0.53; 95% confidence interval [CI] 0.36 to 0.79).
Risk of stroke alone was reduced from 12% to 4% per year (HR 0.34; 95% CI 0.20-0.57).
Among all patients assigned to aspirin, annual incidence of outcome events was 15%, compared with 19% on placebo (HR 0.83, 95% CI 0.65 -1.05).
Anticoagulation was significantly more effective than aspirin (HR 0.60; 95% CI 0.41-0.87).
Incidences of major bleeding events was low: 2.8% per year on anticoagulants, 0.9% on aspirin
No intracranial bleeds were identified in anticoagulation patients.
In multivariate models, six independent predictors of major vascular events were identified: history of previous thromboembolism, ischemic heart disease, enlarged cardiothoracic ratio on chest roentgenogram, systolic blood pressure greater than 160 mm Hg at study entry, atrial fibrillation for more than 1 year, and presence of an ischemic lesion on CT scan.
Anticoagulation is effective in reducing the risk of recurrent vascular events in NRAF patients with recurrent TIA or minor ischemic stroke. In absolute terms: 90 vascular events, mainly strokes, are prevented if 1,000 patients are treated with anticoagulation for 1 year. Aspirin is a safe, though less effective, alternative when anticoagulation is contraindicated. It prevents 40 vascular events for every 1,000 treated patients.
1. Lancet 1993;324:1255-62. Final results
2. Stroke 1995;26:801-6. Predictors of major vascular events
Clinical Topics: Anticoagulation Management
Keywords: Thromboembolism, Stroke, Myocardial Ischemia, Ischemic Attack, Transient, Platelet Aggregation Inhibitors, Warfarin, Blood Pressure
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