Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attacks

Abstract

People with nonrheumatic atrial fibrillation who have had a transient ischemic attack or a minor ischemic stroke are at risk of recurrent stroke. The objective of this review was to assess the effect of anticoagulants for secondary prevention, after a stroke or transient ischaemic attack, in patients with nonrheumatic atrial fibrillation. The reviewer searched the Cochrane Stroke Group trials register and contacted trialists. Randomised trials comparing oral anticoagulants (target International Normalised Ratio range 2.5 to 4.0) with control or placebo in people with nonrheumatic atrial fibrillation and a previous transient ischaemic attack or minor ischaemic stroke. One reviewer assessed trial quality and extracted data. Two trials involving 485 people were included. Anticoagulants reduced the risk of recurrent stroke by two-thirds (odds ratio 0.36, 95% confidence interval 0.22 to 0.58). The risk of all vascular events was shown to be almost halved by treatment (odds ratio 0.55, 95% confidence interval 0.37 to 0.82). No intracranial bleeds were reported among people given anticoagulants. The evidence suggests that anticoagulants are beneficial, without serious adverse effects, for people with nonrheumatic atrial fibrillation and recent cerebral ischaemia.