Stroke Prevention in Atrial Fibrillation III Study - SPAF III


Warfarin for ischemic stroke in atrial fibrillation.


Warfarin should be given to all patients with atrial fibrillation.

Study Design

Study Design:

Patient Populations:

Adults >75 years of age with ECG documentation of atrial fibrillation in the preceding 12 months without prosthetic heart valves, echocardiographic evidence of mitral stenosis, other requirements for or contraindication to aspirin or warfarin therapy.

Primary Endpoints:

Ischemic stroke or systemic embolism

Secondary Endpoints:

Death, myocardial infarction (MI), transient ischemic attack, or unstable angina requiring hospital admission

Drug/Procedures Used:

Standard warfarin group adjusted to prolong prothrombin time to create an international normalized ratio between 2.0 and 3.0, or aspirin, 325 mg/day; or low-dose warfarin, international normalized ratio between 1.2 and 1.5 plus aspirin, 325 mg/day.

Principal Findings:

Not yet available


Conventional dose warfarin is optimal treatment for the majority of patients with atrial fibrillation. Conventional dose warfarin also reduced the incidence of disabling and fatal strokes, MI, and overall mortality.

Warfarin prescribed in low doses is ineffective in preventing stroke in high-risk patients with atrial fibrillation, even when combined with aspirin.


1. Eur Heart J 1996;17:1129. Final results

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Valvular Heart Disease, Acute Heart Failure

Keywords: International Normalized Ratio, Stroke, Prothrombin Time, Warfarin, Mitral Valve Stenosis, Heart Failure, Confidence Intervals, Electrocardiography, Heart Valves

< Back to Listings