Is low-dose aspirin a safe and effective option for primary stroke prevention in patients with atrial fibrillation?
Robert G Hart* and Lesly A Pearce
Correspondence *Department of Medicine (Neurology), University of Texas Health Science Center, 7,703 Floyd Curl Drive, MC 7,883, San Antonio, TX 78229–3900, USA
Email hartr@uthscsa.edu
This article has no abstract so we have provided the first paragraph of the full text.
Antiplatelet therapy reduces the incidence of ischemic stroke and other major vascular events by approximately 25% in a wide variety of patients with vascular diseases.1 Hypothetically, AF patients could be different; in these patients ischemic strokes are the most frequent vascular events, and most strokes are due to embolism of stasis-precipitated thrombi forming in the left atrial appendage. These thrombi are pathologically similar to those arising in veins, and hence the effect of antiplatelet therapy might not be the same in AF patients as in patients with arterial diseases. Meta-analyses of the six randomized trials comparing aspirin with either placebo or control in AF patients show 22–30% reductions in stroke and 16–25% reductions in all-cause death (P = 0.05 and P = 0.10, respectively),2, 3 comparable with aspirin's effect in other patients with vascular diseases.1
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