Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attacks

Abstract

Background: People with nonrheumatic atrial fibrillation who have had a transient ischemic attack or a minor ischemic stroke are at risk of recurrent stroke.

Objectives: The objective of this review was to assess the effect of anticoagulants for secondary prevention, after a stroke or transient ischaemic attack, in patients with nonrheumatic atrial fibrillation.

Search strategy: The reviewer searched the Cochrane Stroke Group trials register and contacted trialists.

Selection criteria: Randomised trials comparing oral anticoagulants (target International Normalised Ratio range 2.5 to 4.0) with control or placebo in people with nonrheumatic atrial fibrillation and a previous transient ischaemic attack or minor ischaemic stroke.

Data collection and analysis: One reviewer assessed trial quality and extracted data.

Main results: Two trials involving 485 people were included. Anticoagulants reduced the risk of recurrent stroke by two-thirds (odds ratio 0.36, 95% confidence interval 0.22 to 0.58). The risk of all vascular events was shown to be almost halved by treatment (odds ratio 0.55, 95% confidence interval 0.37 to 0.82). No intracranial bleeds were reported among people given anticoagulants.

Reviewer's conclusions: The evidence suggests that anticoagulants are beneficial, without serious adverse effects, for people with nonrheumatic atrial fibrillation and recent cerebral ischaemia.