Purpose: We investigated in a prospective study the incidence of new thromboembolic stroke in older persons with chronic atrial fibrillation receiving warfarin (W) versus aspirin (A). Methods: In a prospective study of 312 patients (pts) (208 women and 104 men), mean age 84±7 years, with chronic atrial fibrillation, 125 pts were treated with long-term W to maintain an INR between 2.0 to 3.0 and 187 pts were treated with A 325 mg daily. The incidence of new stroke was determined in pts receiving W versus A. Follow-up was 36±17 months (range 1 to 99 months). Results: Bleeding episodes caused cessation of W in 4 of 125 pts (3%) and cessation of A in 4 of 187 pts (2%) (p not significant). In pts with prior stroke, new stroke developed in 27 of 67 pts (40%) on W and in 56 of 69 pts (81%) on A (p<0.0001, 50% reduction by W). In pts with no prior stroke, new stroke developed in 13 of 58 pts (22%) on W and in 66 or 118 pts (56%) on A (p <0.0001, 60% reduction by W). Cox regression analysis showed that pts taking W had a 76% less chance of developing a new stroke than those taking A after controlling the confounding effects of other risk factors. Conclusions: W was more effective than A in reducing the incidence of new thromboembolic stroke in older persons with atrial fibrillation. Clinical Implications: Older persons with atrial fibrillation at a high risk for developing stroke and without contraindications to W should be treated with W to maintain an INR between 2.0 to 3.0.
|Original language||English (US)|
|Issue number||4 SUPPL.|
|State||Published - Oct 1 1998|
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine