Document Detail


Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group.
MedLine Citation:
PMID:  7901582     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Several studies have established the value of anticoagulation for primary prevention of thromboembolic events in patients with non-rheumatic atrial fibrillation (NRAF). However, in patients with a recent transient ischaemic attack (TIA) or minor ischaemic stroke the preventive benefit of anticoagulation or aspirin remains unclear. Physicians in 108 centres from 13 countries collaborated to study this question. 1007 NRAF patients with a recent TIA or minor ischaemic stroke were randomised to open anticoagulation or double-blind treatment with either 300 mg aspirin per day or placebo (group 1, 669). Patients with contraindications to anticoagulation were randomised to receive aspirin or placebo (group 2,338). The measure of outcome was death from vascular disease, any stroke, myocardial infarction, or systemic embolism. During mean follow-up of 2.3 years, the annual rate of outcome events was 8% in patients assigned to anticoagulants vs 17% in placebo-treated patients in group 1 (hazard ratio [HR] 0.53; 95% confidence interval [CI] 0.36-0.79). The 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 (groups 1 and 2), the annual incidence of outcome events was 15%, against 19% in those 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). The incidence of major bleeding events was low, both on anticoagulation (2.8% per year) and on aspirin (0.9% per year). No intracranial bleeds were identified in patients assigned to anticoagulation. We conclude that anticoagulation is effective in reducing the risk of recurrent vascular events in NRAF patients with a recent TIA or minor ischaemic stroke. In absolute terms: 90 vascular events (mainly strokes) are prevented if 1000 patients are treated with anticoagulation for one year. Aspirin is a safe, though less effective, alternative when anticoagulation is contraindicated; it prevents 40 vascular events each year for every 1000 treated patients.
Authors:
-
Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet     Volume:  342     ISSN:  0140-6736     ISO Abbreviation:  Lancet     Publication Date:  1993 Nov 
Date Detail:
Created Date:  1993-12-09     Completed Date:  1993-12-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1255-62     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / adverse effects,  therapeutic use*
Aspirin / adverse effects,  therapeutic use*
Atrial Fibrillation / complications*
Cerebrovascular Disorders / epidemiology,  etiology,  prevention & control*
Double-Blind Method
Female
Humans
Ischemic Attack, Transient / etiology
Male
Middle Aged
Myocardial Infarction / epidemiology
Recurrence
Survival Analysis
Treatment Outcome
Vascular Diseases / epidemiology,  mortality
Chemical
Reg. No./Substance:
0/Anticoagulants; 50-78-2/Aspirin
Comments/Corrections
Comment In:
ACP J Club. 1994 May-Jun;120 Suppl 3:74
Lancet. 1993 Nov 20;342(8882):1251-2   [PMID:  7901577 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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