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Review: antithrombotic agents prevent stroke in non-valvular atrial fibrillation

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 QUESTION: How efficacious and safe are anticoagulants and antiplatelet agents for preventing stroke in patients with non-valvular atrial fibrillation (AF)?

Data sources

Randomised controlled trials were identified by searching Medline (1966 to 1999), making contact with the Cochrane Collaboration Stroke Review Group and Antithrombotic Trialists Collaboration, and contacting experts.

Study selection

Trials were included if they evaluated long term (>3 mo) use of antithrombotic agents in patients with non-valvular AF. The exclusion criterion was AF associated with prosthetic cardiac valves or mitral stenosis.

Data extraction

Data were extracted on patient numbers, follow up duration, agents studied, type of prevention (primary or secondary), and outcomes (all cause mortality, stroke, ischaemic stroke, intracranial haemorrhage, and major extracranial haemorrhage).

Main results

16 trials (9874 patients) met the inclusion criteria. 10 studies evaluated warfarin. On average, the 1 year risk for stroke in the placebo group was approximately 5% in the primary prevention studies and 12% in the secondary …

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  • Source of funding: National Institute of Neurologic Disorders and Stroke.

  • For correspondence: Dr RG Hart, Department of Medicine (Neurology), University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284, USA. Fax +1 210 567 4659.