Oral Anticoagulation Superior To Aspirin For Stroke Prevention

Oral anticoagulants are more effective than aspirin in preventing strokes caused by the common heart arrhythmia atrial fibrillation (AF), according to the fourth consensus conference report on antithrombotic therapy released last week at CHEST 1995, the 61st annual international assembly of the American College of Chest Physicians.

Refining previously-published clinical guidelines, the ACCP recommends that AF patients with one or more risk factors should be treated with oral anticoagulants. These risk factors include age, a previous stroke or transient ischemic attack, hypertension, diabetes or other forms of heart disease. The report notes that for patients under the age of 65 who have no risk factors, the likelihood of stroke is low, so for them aspirin or no treatment is recommended, but patients over 75 would clearly benefit from oral anticoagulants. However, because there is an age-related risk of bleeding associated with the therapy, the ACCP recommends treatment with a low-intensity regimen.

In making its recommendations, the consensus conference examined results of the six large-scale primary prevention clinical trials and one trial of AF patients who previously had a stroke or TIA. The physicians found that combined results indicate that anticoagulation is twice as effective as aspirin, though for patients at low risk, the increased effectiveness of oral anticoagulation therapy may not justify the inconvenience of regular monitoring and chance of bleeding.