What Are the Main Results of Large Trials of Secondary Prevention with Oral Anticoagulation in Atrial Fibrillation?
Three randomized trials have evaluated long-term anticoagulant therapy in the secondary prevention of stroke for patients with cerebral infarction and a source of cardioembolism. Two of these trials are too small and too old to provide meaningful results. In the European Atrial Fibrillation Trial, 439 patients with NVAF and a recent TIA or minor stroke were randomized to oral anticoagulation (INR 2.5-4.0, target value 3.0) or placebo. The results show that the annual rate of an outcome event (systemic embolism, any stroke, myocardial infarction, or vascular death), is 17% in patients given placebo and 8% in patients treated with oral anticoagulants. A 47% reduction of the risk (95% CI: 21-64%) is obtained. The annual rate of all strokes alone is reduced from 12% with placebo to 4% with oral anti-coagulation (66% of reduction (95% CI: 43-80%,)). In addition, 100 patients treated for 1 year with oral anticoagulants (INR 2.5-4.0) have nine fewer vascular events (mainly strokes). The annua
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