A Cochrane review [Abstract]2 included two trials with a total of 1371 patients. The patients had a nonrheumatic atrial fibrillation (NRAF) and transient ischemic attack (TIA) or minor stroke. In the other trial (n=455), patients received either anticoagulants (INR 2.5 to 4.0) or aspirin (300 mg/day) within 3 months of transient ischemic attack (TIA) or minor stroke. The mean follow up was 2.3 years. In another trial (n=916), patients with NRAF received open label anticoagulants (INR 2.0 to 3.5) or indobufen (a reversible platelet cyclooxygenase inhibitor, 100 or 200 mg BID) within 15 days of TIA or minor stroke. The follow-up period was one year. In the combined results (2 trials, n=1371), anticoagulants were shown to be significantly more effective than antiplatelet therapy both for all vascular events (Peto OR 0.67, 95% CI 0.50 to 0.91) and for recurrent stroke (OR 0.49, 95% CI 0.33 to 0.72). Major extracranial bleeding complications occurred more often in patients on anticoagulants (OR 5.16, 95% CI 2.08 to 12.83), but the absolute difference was small (2.8% per year vs. 0.9% per year and 0.9% per year vs. 0% in 2 trials, respectively). Warfarin did not cause a significant increase of intracranial bleeds.
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