Oral Anticoagulants vs Aspirin in Nonvalvular Atrial Fibrillation

Authors:
  • RHRobert G. Hart
    Robert G. Hart
  • DSDaniel E. Singer
    Daniel E. Singer
  • ALAndreas Laupacis
    Andreas Laupacis
  • SCStuart Connolly
    Stuart Connolly
  • PPPalle Petersen
    Palle Petersen
  • PKPeter J. Koudstaal
    Peter J. Koudstaal
  • YCYuchiao Chang
    Yuchiao Chang
  • BHBeppie Hellemons
    Beppie Hellemons
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Abstract
Nonvalvular atrial fibrillation (AF) more than quadruples the risk of stroke.1 Stroke prophylaxis in patients with atrial fibrillation has been examined extensively in randomized trials,2-16 analyses of individual patient-level data,17-19 traditional meta-analyses,20-31 and review articles.32-42 The clinical trials, and their quantitative reviews, show that treatment with vitamin K–dependent oral anticoagulants significantly decrease the risk of stroke in AF patients by more than 50%. Acetylsalicylic acid (aspirin) also appears to decrease stroke risk but to a lesser extent.20 Because oral anticoagulant use is more troublesome43 and has a greater likelihood of complications,44 it is important to determine the relative efficacy and safety of oral anticoagulant vs aspirin overall and in relevant patient subgroups.

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