Document Detail

Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. The European Atrial Fibrillation Trial Study Group.
MedLine Citation:
PMID:  7776995     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: A number of studies have demonstrated the efficacy of oral anticoagulant therapy in reducing the risk of stroke and systemic embolism in patients with nonrheumatic atrial fibrillation. However, both the targeted and the actual levels of anticoagulation differed widely among the studies, and a number of studies failed to report standardized prothrombin-time ratios as international normalized ratios (INRs). We therefore performed an analysis to determine the intensity of oral anticoagulant therapy in nonrheumatic atrial fibrillation that provides the best balance between the prevention of thromboembolism and the occurrence of bleeding complications. METHODS: We calculated INR-specific incidence rates for both ischemic and major hemorrhagic events occurring in 214 patients who received anticoagulant therapy in the European Atrial Fibrillation Trial, a secondary-prevention trial in patients with nonrheumatic atrial fibrillation and a recent episode of minor cerebral ischemia. RESULTS: The optimal intensity of anticoagulation was found to lie between an INR of 2.0 and an INR of 3.9. No treatment effect was apparent with anticoagulation below an INR of 2.0. The rate of thromboembolic events was lowest at INRs from 2.0 to 3.9, and most major bleeding complications occurred with treatment at intensities with INRs of 5.0 or above. CONCLUSIONS: To achieve optimal levels of anticoagulation with the lowest risk in patients with atrial fibrillation and a recent episode of cerebral ischemia, the target value for the INR should be set at 3.0, and values below 2.0 and above 5.0 should be avoided.
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  333     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1995 Jul 
Date Detail:
Created Date:  1995-07-07     Completed Date:  1995-07-07     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  5-10     Citation Subset:  AIM; IM    
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MeSH Terms
Anticoagulants / administration & dosage*,  adverse effects
Atrial Fibrillation / complications*,  drug therapy
Brain Ischemia / complications*,  drug therapy
Cerebrovascular Disorders / epidemiology,  etiology,  prevention & control*
Dose-Response Relationship, Drug
Double-Blind Method
Embolism / epidemiology,  etiology,  prevention & control
Heart Diseases / epidemiology,  etiology
Hemorrhage / chemically induced*,  epidemiology
Ischemic Attack, Transient / complications
Middle Aged
Prothrombin Time*
Reg. No./Substance:
Comment In:
N Engl J Med. 1995 Jul 6;333(1):54-5   [PMID:  7776998 ]
N Engl J Med. 1995 Nov 30;333(22):1504   [PMID:  7477157 ]

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