SPAF IIIStroke Prevention in Atrial Fibrillation III study |
| Authors: |
(a) Zabalgoitia M
(b) Cowburn P, Cleland JGF |
| Titles: |
(a) Stroke prevention in atrial fibrillation III and trans- oesophageal echo study. Design and progress report
(b) SPAF-III results |
| References: |
(a) Eur Heart J 1994;15(abstr suppl):28
(b) Eur Heart J 1996;17:1129 |
| Disease: |
Atrial fibrillation |
| Purpose: |
To assess whether a combination of fixed, low-dose warfarin and aspirin is as effective as, but safer and better tolerated than, adjusted-dose warfarin in high-risk patients with atrial fibrillation (AF). Secondary objectives: to establish that an acceptably low rate of stroke (< 3% per year) can be achieved by aspirin alone in low-risk AF patients, and to evaluate transoesophageal echo (TEE) for selection of antithrombotic therapy |
| Study Design: |
Not stated |
| Follow-up: |
3 years |
| Patients: |
1724 patients with atrial fibrillation, including 680 with no risk factors for the subsequent development of stroke (low-risk group) and 1044 with at least one risk factor (high-risk group). In the latter group, the mean age was 72 years and 45% of patients had heart failure |
| Treatmentregimen: |
Low-risk patients: aspirin, 325 mg/day. High-risk patients: warfarin, at a dose sufficient to maintain the international normalised ratio (INR) between 2.0 and 3.0 (conventional anticoagulation therapy), or warfarin in a fixed dose of 0.5-3.0 mg/day, adj |
| Results: |
The low-risk trial is ongoing, and the high- risk trial was terminated prematurely due to an excess of strokes in the low-dose warfarin group. The annualised rate of primary events was 7.9% in the low-dose warfarin group and 1.9% in the conventional warfarin group. Conventional dose warfarin should be regarded as the optimal treatment for the majority of patients with atrial fibrillation |
