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What about alternatives to oral anticoagulation? Aspirin is commonly given to patients who are at risk of stroke but who are thought to have too high a risk of bleeding. The Figure looks at 3 groups of patients with AFib and at risk for stroke, treated with warfarin vs no therapy (1st column),[69] aspirin vs no therapy (2nd column),[70] and warfarin vs aspirin (3rd column).[71] In the first column, the relative risk reduction for stroke with warfarin vs no therapy is 68%,[69] whereas the relative risk reduction with aspirin vs no therapy is a far more modest 21%.[70] Finally, comparing warfarin vs. aspirin, warfarin provided a 52% greater risk reduction than aspirin.[71] In sum, antiplatelet therapy with aspirin does provide modest risk reduction compared with placebo (no therapy), but aspirin is clearly inferior to warfarin.
Rothman SA. Am J Med 2013; 126: 00-00.
[69] Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med. 1994;154:1449-1457.
[70] The Atrial Fibrillation Investigators. The efficacy of aspirin in patients with atrial fibrillation. Analysis of pooled data from 3 randomized trials. Arch Intern Med. 1997;157:1237-1240.
[71] Van Walraven C, Hart RG, Singer DE, et al. Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis. JAMA. 2002;288:2441-2448.