SPINAFStroke Prevention in Nonrheumatic Atrial Fibrillation |
| Authors: |
Ezekowitz MD, Bridgers SL, James KE et al |
| Titles: |
Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation |
| References: |
N Engl J Med 1992;327:1406-12 |
| Disease: |
Nonrheumatic atrial fibrillation |
| Purpose: |
To investigate whether anticoagulation with warfarin would reduce the risk of stroke associated with nonrheumatic atrial fibrillation |
| Study Design: |
Randomised, double-blind, placebo- controlled |
| Follow-up: |
3 years |
| Patients: |
571 men with chronic nonrheumatic atrial fibrillation, of whom 46 had had a previous cerebral infarction |
| Treatmentregimen: |
Warfarin, given as 2 mg tablets to maintain an international normalised ratio of 1.4-2.8, or placebo |
| Results: |
For patients with no history of stroke receiving placebo, cerebral infarction occurred in 4.3% per year compared to 0.9% per year for the warfarin group. The risk reduction with warfarin was 0.79 (p = 0.001). The annual event rate for patients aged > 70 years was 4.8% in the placebo group and 0.9% in the warfarin group (risk reduction 0.79; p = 0.02). Cerebral infarction was more common among patients with a history of cerebral infarction, 9.3% per year in the placebo group and 6.1% per year in the warfarin group. Both major and minor haemorrhages were slightly more common in the warfarin group |
