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Anticoagulation vs. Antiplatelet Therapy for Nonrheumatic Atrial Fibrillation

Anticoagulation is preferred widely over antiplatelet therapy for patients with nonrheumatic atrial fibrillation, based largely on the results of randomized trials that compared each type of therapy with placebo. This meta-analysis centered on head-to-head comparisons, to minimize differences in patient selection between trials. Five randomized trials, published between 1989 and 1999 and including 3298 patients, met inclusion criteria.

Eighty-two fatal vascular events occurred among patients who received anticoagulation and 95 occurred among patients who received antiplatelet therapy. There were nonsignificant trends in favor of anticoagulation for deaths from stroke (pooled odds ratio, 0.74) and vascular death (OR, 0.86), and for combined fatal and nonfatal events (OR, 0.79). In 1 study, there was a significant benefit from anticoagulation, but this study was methodologically weaker than the others. A nonsignificant trend toward more bleeding with anticoagulation (OR, 1.45) was observed. Finally, the primary annual event rate varied from 1.7 percent to 10.6 percent, reflecting considerable heterogeneity among the studied populations.

Comment: Although the pooled effects on mortality were not significant, the confidence intervals were wide: For vascular deaths, anticoagulation may be up to 37 percent better than aspirin or as much as 17 percent worse. Overall, any advantage of anticoagulation over antiplatelet therapy appears to be marginal. It will take larger studies to establish the true costs and benefits of each therapy.

— KI Marton

Published in Journal Watch General Medicine March 2, 2001

Citation(s):

Taylor FC et al. Systematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrial fibrillation. BMJ 2001 Feb 10 322 321-326.

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