Warfarin vs aspirin to prevent stroke

[Marty]

In the Elderly, Warfarin Superior to Aspirin for Preventing Stroke

Warfarin is more effective than aspirin in preventing stroke, intracranial
hemorrhage, and arterial embolism among elderly patients with atrial
fibrillation, the Lancet reports.

Researchers randomized 973 patients over 75 years of age with atrial
fibrillation either to warfarin (target INR, 2 to 3) or to 75 mg of aspirin
daily. After an average follow-up of 2.7 years, the warfarin group had an annual
relative risk of 0.48 for stroke, intracranial hemorrhage, or embolism. The
number needed to treat for 1 year to prevent a primary event was 50. There was
no difference between the groups in the risk for major hemorrhage -- a result
the authors called "surprising."

Editorialists, citing the study's "unprecedented number of patients in an age
group that has been largely under-represented in randomised trials," say it
"firmly establishes the superior efficacy of warfarin as a stroke-prevention
strategy in elderly patients with atrial fibrillation."

Link(s):
Lancet article (Free abstract with one-time registration; full text requires
subscription) http://click2.nejm.org/cts/click?q=227;295775;/2rc5BVe6mK+pTBjADvaB2PxPDV7HKTaIJ8F3gmBEVQ=
Lancet comment (Subscription required) http://click2

 

[ALCapshaw2]

In the Elderly, Warfarin Superior to Aspirin for Preventing Stroke

Warfarin is more effective than aspirin in preventing stroke, intracranial
hemorrhage, and arterial embolism among elderly patients with atrial
fibrillation, the Lancet reports.

Researchers randomized 973 patients over 75 years of age with atrial
fibrillation either to warfarin (target INR, 2 to 3) or to 75 mg of aspirin
daily. After an average follow-up of 2.7 years, the warfarin group had an annual
relative risk of 0.48 for stroke, intracranial hemorrhage, or embolism. The
number needed to treat for 1 year to prevent a primary event was 50. There was
no difference between the groups in the risk for major hemorrhage -- a result
the authors called "surprising."

Editorialists, citing the study's "unprecedented number of patients in an age
group that has been largely under-represented in randomised trials," say it
"firmly establishes the superior efficacy of warfarin as a stroke-prevention
strategy in elderly patients with atrial fibrillation."

Link(s):
Lancet article (Free abstract with one-time registration; full text requires
subscription) http://click2.nejm.org/cts/click?q=227;295775;/2rc5BVe6mK+pTBjADvaB2PxPDV7HKTaIJ8F3gmBEVQ=
Lancet comment (Subscription required) http://click2

HUH ???

I understand the first and third paragraphs, but see NO corroborating evidence.

The middle paragraph only gives numbers from ONE group (i.e. NO comparison) and the numbers are MEANINGLESS without units or explanation.

The middle sentence is TOTALLY incomprehensible to me.
(The number needed to treat for 1 year to prevent a primary event was 50).

"The number" (of WHAT) needed to treat (WHAT) for 1 year was 50 (WHAT)? HUH? Even the English can't seem to write comprehensible English!

'AL Capshaw'

 

[Marty]

HUH ???

I understand the first and third paragraphs, but see NO corroborating evidence.

The middle paragraph only gives numbers from ONE group (i.e. NO comparison) and the numbers are MEANINGLESS without units or explanation.

The middle sentence is TOTALLY incomprehensible to me.
(The number needed to treat for 1 year to prevent a primary event was 50).

"The number" (of WHAT) needed to treat (WHAT) for 1 year was 50 (WHAT)? HUH? Even the English can't seem to write comprehensible English!

'AL Capshaw'

Al, If you are going to follow the medical literature you have to get used to the gobbeldy gook arcane verbiage. As you suspect much of it is B/S and published to buff up the resume. However I liked the article because I think warfarin is good for you. I was particularly happy with their finding that warfarin did not seem to increase the incidence of hemmorrhagic stroke.

 

[tobagotwo]

A couple of thoughts...

- In the US, the aspirin purchased everywhere for stroke prevention is 81MG, not 75MG.

- The study doesn't say if the aspirin was enterically coated. A Scottish study showed that enterically coated aspirin was about half as effective, as it is less fully absorbed. As almost all US 81MG aspirin are enterically coated, I take two daily, to ensure I am absorbing a useful dose. As a standard aspirin (formerly 5 grains) is now 325MG, it's still less than a half of an aspirin.

- You're right. It doesn't give any comparison number for aspirin. There's no reason to believe that warfarin isn't superior to aspirin for avoiding strokes after 75. It most likely is. It's just that this article doesn't prove it.

Best wishes,