BMJ 2001;323:233 ( 28 July )

Letters

Long term anticoagulation or antiplatelet treatment

    Only warfarin has been shown to reduce stroke risk in patients with atrial fibrillation
    Inclusion criteria determine results of review
    Garbage in equals garbage out
    Drug name was incorrect
    Giving warfarin always depends on balancing risks
    Patients at risk of stroke should be given warfarin
    How do we decide between warfarin and aspirin?
    Author's reply

Only warfarin has been shown to reduce stroke risk in patients with atrial fibrillation

The first 150 words of the full text of this article appear below.

EDITOR---The conclusions of Taylor et al about the use of aspirin for atrial fibrillation are misleading and potentially dangerous for clinical practice.1

Firstly, when considering anticoagulation or aspirin for the management of heart failure it is appropriate first to compare each against placebo. Overall, aspirin has no effect compared with placebo in preventing thromboembolic events or death among patients with atrial fibrillation, whereas warfarin exerts a significant reduction in both outcomes compared with placebo.2

Secondly, Taylor et al excluded a key study, stroke prevention in atrial fibrillation (SPAF) III, from their analysis.3 This study showed that full dose warfarin versus low dose warfarin combined with aspirin exerted a significantly greater reduction in stroke (1.7% v 5.6%; P=0.0007) with a trend to reduced total mortality (5.9% v 7.2%).3

Thirdly, the BMJ has previously published the mortality data from the aspirin (28 deaths) and placebo (30 deaths) arms of the AFASAK study, . . . [Full text of this article]
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Relevant Articles

Systematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrial fibrillation
F C Taylor, H Cohen, and S Ebrahim
BMJ 2001 322: 321-326. [Abstract] [Full Text] [PDF]

Primary prevention of arterial thromboembolism in non-rheumatic atrial fibrillation in primary care: randomised controlled trial comparing two intensities of coumarin with aspirin
B S P Hellemons, M Langenberg, J Lodder, F Vermeer, H J A Schouten, Th Lemmens, J W van Ree, and J A Knottnerus
BMJ 1999 319: 958-964. [Abstract] [Full Text] [PDF]

Rapid Responses:

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Cheeky error
S H Guptha
bmj.com, 27 Jul 2001 [Full text]
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