Placebo-Controlled, Randomised Trial of Warfarin and Aspirin for Prevention of Thromboembolic Complications in Chronic Atrial Fibrillation

Petersen, Palle; Boysen, Gudrun; Godtfredsen, John; Andersen, E; Andersen, B

doi:10.1016/s0140-6736(89)91200-2

Cited by 1,671 publications

(798 citation statements)

References 20 publications

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“…Important classes of drugs to identify include antiplatelet and anticoagulant medications, which may increase the risk of haemorrhagic anaesthetic or operative complications. These medications are, however, taken to reduce the incidence of potentially life-threatening thromboembolic events in patients with cardiovascular conditions; [1][2][3][4][5] therefore, so long as they do not threaten the success of cataract surgery, it is desirable to continue them before surgery.…”

Section: Introductionmentioning

confidence: 99%

The Cataract National Dataset electronic multicentre audit of 55 567 operations: antiplatelet and anticoagulant medications

Benzimra

Johnston

Jaycock

et al. 2008

Eye

105

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Aims This study aims to establish the prevalence of aspirin, dipyridamole, clopidogrel, and warfarin use in patients undergoing cataract surgery, and to compare local anaesthetic and intraoperative complication rates between users and non-users. Methods The Cataract National Dataset was remotely extracted and anonymised on 55 567 operations at 12 NHS Trusts using electronic patient records (EPRs) between 2001 and 2006. Results This report analyses 48 862 of the 55 567 operations from the eight centres, which routinely recorded a drug history. In all, 28.1% of the 48 862 patients were taking aspirin, 5.1% warfarin, 1.9% clopidogrel, and 1.0% dipyridamole. The recording of any complication of a sharp needle or subtenon's cannula local anaesthetic block was increased in patients taking clopidogrel, 8.0% (Po0.0001) or warfarin, 6.2% (P ¼ 0.0026) vs non-users, 4.3%, but no increase in potentially sight-threatening complications was identified. The incidence of subconjunctival haemorrhage was increased in patients taking clopidogrel, 4.4% (Po0.0001) or warfarin, 3.7% (Po0.0001) vs non-users, 1.7%. The recording of any operative complication was increased in those taking clopidogrel, 7.3% (P ¼ 0.0002) vs non-users, 4.4%, but the haemorrhagic operative complications of choroidal/ suprachoroidal haemorrhage and hyphaema were not significantly increased. The non-haemorrhagic complication of posterior capsular rupture (PCR) was increased in those taking clopidogrel, 3.23% (P ¼ 0.0057) vs non-users, 1.77%.Conclusions Clopidogrel or warfarin use was associated with a significant increase in minor complications of sharp needle and subtenon's cannula local anaesthesia but was not associated with a significant increase in potentially sight-threatening local anaesthetic or operative haemorrhagic complications.

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Section: Introductionmentioning

confidence: 99%

The Cataract National Dataset electronic multicentre audit of 55 567 operations: antiplatelet and anticoagulant medications

Benzimra

Johnston

Jaycock

et al. 2008

Eye

105

View full text Add to dashboard Cite

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“…Multiple studies have identified these risk factors for stroke in patients with AF. These include the Atrial Fibrillation Investigators (AFI), the Boston Area Anticoagulation Trial of Atrial Fibrillation Investigators (BAATAF) [40], Stroke Prevention in Atrial Fibrillation (SPAF) [41,42], Stroke Prevention in Nonrheumatic Atrial Fibrillation (SPINAF), Copenhagen Atrial Fibrillation, Aspirin, and Anticoagulation Study (AFA-SAK) [43], and Canadian Atrial Fibrillation Anticoagulation (CAFA) study [44]. Several stroke risk stratification schemes have been proposed [45,46], and one scheme has not been definitely proven superior to another scheme or 100% predictive of ischemic stroke risk [45,46].…”

Section: Stroke Prevention In Afmentioning

confidence: 99%

Prevention of Cardioembolic Stroke

Freeman

Aguilar

2011

Neurotherapeutics

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Cardiac causes of ischemic stroke lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic stroke. The most common cause of cardioembolic stroke is atrial fibrillation (AF), which has an increasing incidence with age. AF stroke trials demonstrate that anti-coagulation is superior to anti-platelet therapy in terms of ischemic stroke prevention. Recently, warfarin was compared with dabigatran, an oral, direct thrombin inhibitor, and was found to be at least equally effective in reducing ischemic stroke with less intracranial bleeding risk. Future research is investigating other direct thrombin inhibitors as potential alternatives to warfarin, which has a narrow therapeutic index, requires frequent blood monitoring, has multiple drug interactions, and a higher rate of intracranial bleeding. Other causes of cardioembolic stroke include myocardial infarction, left ventricular thrombus, reduced ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale is a common finding on echocardiograms in patients with and without stroke (up to 20% of the population), and it is a controversial source of cryptogenic stroke. The best way to prevent cardioembolic stroke remains early detection and treatment of AF, and treating the underlying stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating cardioembolic stroke.

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“…Several randomized trials have assessed the ability of warfarin or aspirin to reduce the risk of AF-associated stroke. [84][85][86][87][88][89][90][91] Hart et al 82 pooled the data from these trials to compare the effectiveness of adjusted-dose warfarin vs placebo, aspirin vs placebo, and adjusted-dose warfarin vs aspirin for the prevention of stroke among patients with AF. This metaanalysis showed that adjusted-dose warfarin is remarkably effective in reducing the risk of stroke for patients with AF.…”

Section: Preventing Stroke In Patients With Afmentioning

confidence: 99%

Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies

Crandall

Bradley

Packer

et al. 2009

Mayo Clinic Proceedings

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Placebo-Controlled, Randomised Trial of Warfarin and Aspirin for Prevention of Thromboembolic Complications in Chronic Atrial Fibrillation

Cited by 1,671 publications

References 20 publications

The Cataract National Dataset electronic multicentre audit of 55 567 operations: antiplatelet and anticoagulant medications

The Cataract National Dataset electronic multicentre audit of 55 567 operations: antiplatelet and anticoagulant medications

Prevention of Cardioembolic Stroke

Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies

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