BACKGROUND: Warfarin for stroke prevention in patients with atrial fibrillation (AF) is well documented. However, it has not been examined in the prevention of systemic embolism. OBJECTIVES: To evaluate the efficacy of warfarin in preventing systemic embolism (embolism to limbs or viscera) in patients with AF. METHODS AND RESULTS: A combined Medline, Embase, Cochrane Library and SveMed+ search were made. Fifteen studies were included. Warfarin was better than antiplatelet agents for preventing systemic embolism with a 50% reduction of risk (odds ratio (OR) = 0.50, 95% CI 0.33 to 0.75) without increasing the risk of major bleeding (OR = 1.07; 95% CI 0.85 to 1.34). Warfarin compared with placebo resulted in a risk reduction of 71% (OR = 0.29; 95% CI 0.08 to 1.07) with higher risk of major bleeding with warfarin (OR = 3.01; 95% CI 1.31 to 6.92). Results of a comparison of warfarin with low-dose warfarin (OR = 1.52; 95% CI 0.40 to 5.81) or low-dose warfarin with aspirin (OR = 1.00; 95% CI 0.17 to 5.81) were inconclusive. CONCLUSIONS: Warfarin not only reduces the risk of stroke but is also better than placebo and antiplatelet agents in prevention of systemic embolism in patients with non-valvular AF. Warfarin increases the risk of major bleeding compared with placebo but not compared with antiplatelet agents.
BACKGROUND:Warfarin for stroke prevention in patients with atrial fibrillation (AF) is well documented. However, it has not been examined in the prevention of systemic embolism. OBJECTIVES: To evaluate the efficacy of warfarin in preventing systemic embolism (embolism to limbs or viscera) in patients with AF. METHODS AND RESULTS: A combined Medline, Embase, Cochrane Library and SveMed+ search were made. Fifteen studies were included. Warfarin was better than antiplatelet agents for preventing systemic embolism with a 50% reduction of risk (odds ratio (OR) = 0.50, 95% CI 0.33 to 0.75) without increasing the risk of major bleeding (OR = 1.07; 95% CI 0.85 to 1.34). Warfarin compared with placebo resulted in a risk reduction of 71% (OR = 0.29; 95% CI 0.08 to 1.07) with higher risk of major bleeding with warfarin (OR = 3.01; 95% CI 1.31 to 6.92). Results of a comparison of warfarin with low-dose warfarin (OR = 1.52; 95% CI 0.40 to 5.81) or low-dose warfarin with aspirin (OR = 1.00; 95% CI 0.17 to 5.81) were inconclusive. CONCLUSIONS:Warfarin not only reduces the risk of stroke but is also better than placebo and antiplatelet agents in prevention of systemic embolism in patients with non-valvular AF. Warfarin increases the risk of major bleeding compared with placebo but not compared with antiplatelet agents.
Authors: Noa Zemer-Wassercug; Moti Haim; Dorit Leshem-Lev; Katia L Orvin; Muthiah Vaduganathan; Ariel Gutstein; Ehud Kadmon; Aviv Mager; Ran Kornowski; Eli I Lev; Eli L Lev Journal: J Thromb Thrombolysis Date: 2015-10 Impact factor: 2.300
Authors: Claudia L Zeballos-Palacios; Ian G Hargraves; Peter A Noseworthy; Megan E Branda; Marleen Kunneman; Bruce Burnett; Michael R Gionfriddo; Christopher J McLeod; Haeshik Gorr; Juan Pablo Brito; Victor M Montori Journal: Mayo Clin Proc Date: 2019-01-11 Impact factor: 7.616
Authors: Theresa M Lee; Noah M Ivers; Sacha Bhatia; Debra A Butt; Paul Dorian; Liisa Jaakkimainen; Kori Leblanc; Dan Legge; Dante Morra; Alissia Valentinis; Laura Wing; Jacqueline Young; Karen Tu Journal: Implement Sci Date: 2016-12-03 Impact factor: 7.327
Authors: G Biondi-Zoccai; V Malavasi; F D'Ascenzo; A Abbate; P Agostoni; M Lotrionte; D Castagno; B Van Tassell; E Casali; M Marietta; M G Modena; K A Ellenbogen; G Frati Journal: HSR Proc Intensive Care Cardiovasc Anesth Date: 2013