Open AccessEvidence-based study on antithrombotic therapy in patients at risk of a stroke with paroxysmal atrial fibrillation
Author(s) -
Xinjun Chen,
Ru Wan,
Wenlong Jiang,
Hua Zhang,
Ruolong Zhen,
Quanzhong Ying,
Weizhang Li,
Hai-Yan Qian,
Wei Feng,
Zhengrui Xu,
Jingrong Tang,
Handong Lei,
Yi Zhou
Publication year - 2013
Publication title -
experimental and therapeutic medicine
Language(s) - English
Resource type - Journals
eISSN - 1792-1015
pISSN - 1792-0981
DOI - 10.3892/etm.2013.1141
Subject(s) - antithrombotic , atrial fibrillation , paroxysmal atrial fibrillation , stroke (engine) , medicine , cardiology , molecular medicine , cancer , cell cycle , mechanical engineering , engineering
The aim of the present study was to determine the optimal intensity of anticoagulation therapy in elderly patients with paroxysmal atrial fibrillation (PAF), using aspirin and varied concentrations of warfarin. Elderly patients with PAF (n=1,162) who met the inclusion criteria of the study and were at middle or high-risk of a stroke were investigated. Patients were divided into six groups (four high-risk groups and two middle-risk groups). Patients were treated with aspirin or varied concentrations of warfarin. The primary endpoint events, secondary endpoint events, major bleeding events and minor bleeding events were observed and compared. In high-risk elderly patients, warfarin significantly reduced primary and secondary endpoint events, total primary events and total events compared with aspirin. In middle-risk elderly patients, for all the events warfarin demonstrated no significant difference compared with aspirin. In high-risk patients with PAF, when the concentration of warfarin was adjusted to target international normalized ratio (INR) range 1.7-2.5, the primary and secondary endpoint events, total primary events and total events were significantly lower (P<0.05), compared with aspirin and warfarin at INR 1.2-1.6. When the intensity of warfarin was adjusted to the target INR 2.6-3.0, the primary and secondary endpoint events were significantly lower (P<0.05) compared with aspirin and warfarin INR at 1.2-1.6. This study determined that in high-risk elderly patients with PAF, warfarin is recommended for anticoagulation with an optimal INR range of 1.7-2.5. In patients at a middle-risk of a stroke, aspirin is the recommended treatment as an antithrombotic as results have indicated that there is limited benefit in the use of warfarin.