LONG-TERM ANTITHROMBOTIC TREATMENT FOR ATRIAL-FIBRILLATION

Nonvalvular atrial fibrillation (AF) is the most common cardiac disord er causing stroke and systemic emboli, Recent clinical trials have cle arly demonstrated the effects of antithrombotic treatment in preventin g these devastating complications of AF, This review summarizes the sa lient findings of the first 5 published studies-the Atrial Fibrillatio n, Aspirin, Anticoagulation Study (AFASAK) from Copenhagen, Denmark; t he Boston Area Anticoagulation Trial for Atrial Fibrillation (BATAFF); the Canadian Atrial Fibrillation Anticoagulation study (CAFA); the St roke Prevention in Non-rheumatic Atrial Fibrillation (SPINAF) study; a nd the Stroke Prevention in Atrial Fibrillation study (SPAF I) from th e United States, These trials emphasize the unequivocal benefits of wa rfarin therapy compared with no treatment. SPAF II showed that aspirin is quite effective in younger patients (<75 years) who have no risk f actors. The European Atrial Fibrillation Trial (EAFT) and SPAF III dem onstrated that in older patients (>75 years) who had associated risk f actors, warfarin therapy at the target international normalized ratio (INR) of 2-3, is the best treatment; however, a combination of low int ensity fixed-dose warfarin and aspirin is ineffective. Thus, the guide lines recommended by the American College of Chest Physicians should b e followed in treating patients with AF. (C)1998 by Excerpta Medica, I nc.