The Lancet Table of Contents Volume 370 Issue 9586
Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial
Jonathan Mant, FD Richard Hobbs, Kate Fletcher, Andrea Roalfe, David Fitzmaurice, Gregory YH Lip, Ellen Murray, on behalf of the BAFTA investigators, the Midland Research Practices Network (MidReC)
Nella saga infinita sulla maggiore o minore efficacia della terapia anticoagulante nella prevenzione dell'ictus in pazienti con fibrillazione atriale si aggiunge un nuovo capitolo, o meglio un nuovo studio dalla prestigiosa ribalta del Lancet. Il risultato è ancora una volta a favore della terapia anticoagulante rispetto all'aspirina, mostrando tra l'altro un eguale numero di complicanze emorragiche tra i due gruppi, risultato a detta degli autori sorprendente.
Warfarin is more effective than aspirin in preventing stroke, intracranial hemorrhage, and arterial embolism among elderly patients with atrial fibrillation, the Lancet reports.
Researchers randomized 973 patients over 75 years of age with atrial fibrillation either to warfarin (target INR, 2 to 3) or to 75 mg of aspirin daily. After an average follow-up of 2.7 years, the warfarin group had an annual relative risk of 0.48 for stroke, intracranial hemorrhage, or embolism. The number needed to treat for 1 year to prevent a primary event was 50. There was no difference between the groups in the risk for major hemorrhage -- a result the authors called "surprising."
Editorialists, citing the study's "unprecedented number of patients in an age group that has been largely under-represented in randomised trials," say it "firmly establishes the superior efficacy of warfarin as a stroke-prevention strategy in elderly patients with atrial fibrillation."