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. 2004;2004(2):CD000185.
doi: 10.1002/14651858.CD000185.pub2.

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

R Saxena  1 , P J Koudstaal
Affiliations

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

R Saxena et al. Cochrane Database Syst Rev. 2004.

Abstract

Background: People with nonrheumatic atrial fibrillation (NRAF) who have had a transient ischaemic attack (TIA) or a minor ischaemic stroke are at high risk of recurrent stroke.

Objectives: The objective of this review was to assess the effect of anticoagulants for secondary prevention, after a stroke or TIA, in patients with NRAF.

Search strategy: We searched the Cochrane Stroke Group trials register (9 June 2003) and contacted trialists.

Selection criteria: Randomised trials comparing oral anticoagulants with control (no therapy) or placebo in people with NRAF and a previous TIA or minor ischaemic stroke. Control groups on aspirin did not meet the selection criteria.

Data collection and analysis: Both reviewers assessed trial quality and extracted data.

Main results: Two trials involving 485 people were included. Follow-up time was 1.7 years in one trial and 2.3 years in the other. Anticoagulants reduced the odds of recurrent stroke by two-thirds (odds ratio (OR) 0.36, 95% confidence interval (CI) 0.22 to 0.58). The odds of all vascular events was shown to be almost halved by treatment (OR 0.55, 95% CI 0.37 to 0.82). The odds of major extracranial haemorrhage was increased (OR 4.32, 95% CI 1.55 to 12.10). No intracranial bleeds were reported among people given anticoagulants.

Reviewers' conclusions: The evidence suggests that anticoagulants are beneficial, without serious adverse effects, for people with NRAF and recent cerebral ischaemia.

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Conflict of interest statement

PJ Koudstaal was the principal investigator of the European Atrial Fibrillation Trial (EAFT).

Figures

1.1
1.1. Analysis
Comparison 1 Anticoagulants vs control, Outcome 1 All vascular events.
1.2
1.2. Analysis
Comparison 1 Anticoagulants vs control, Outcome 2 Recurrent stroke.
1.3
1.3. Analysis
Comparison 1 Anticoagulants vs control, Outcome 3 Any intracranial bleed.
1.4
1.4. Analysis
Comparison 1 Anticoagulants vs control, Outcome 4 Major extracranial bleed.
See this image and copyright information in PMC

Update of

References

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