老年心房纤颤者华法林预防卒中优于阿司匹林

Title: Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial
题目：华法林与阿斯匹林对预防老年心房纤颤者卒中的比较（伯明翰对老年心房纤颤治疗的研究）随机的对照试验阿司匹林
Author: Dr Jonathan Mant MD , Prof FD Richard Hobbs FMedSci , Kate Fletcher BA , et al
作者：Dr Jonathan Mant MD , Prof FD Richard Hobbs FMedSci , Kate Fletcher BA，等等

Summary
Background
Anticoagulants are more effective than antiplatelet agents at reducing stroke risk in patients with atrial fibrillation, but whether this benefit outweighs the increased risk of bleeding in elderly patients is unknown. We assessed whether warfarin reduced risk of major stroke, arterial embolism, or other intracranial haemorrhage compared with aspirin in elderly patients.
摘要
背景
抗凝剂减少房颤患者卒中的危险性优于抗血小板因子，但是这个好处是否超过老年病人出血的危险性还不知道。我们评价了华法林在减少老年病人较大卒中，动脉栓塞或其他颅内出血的危险性方面是否优于阿斯匹林。
Methods
973 patients aged 75 years or over (mean age 81•5 years, SD 4•2) with atrial fibrillation were recruited from primary care and randomly assigned to warfarin (target international normalised ratio 2–3) or aspirin (75 mg per day). Follow-up was for a mean of 2•7 years (SD 1•2). The primary endpoint was fatal or disabling stroke (ischaemic or haemorrhagic), intracranial haemorrhage, or clinically significant arterial embolism. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN89345269.
方法
我们在初级护理中选了973个75岁，或更大（平均年龄是81.5岁，标准偏差4.2）有房颤的病人，然后随机分到华法林组（按国际标准化比率2-3）或阿斯匹林组（75mg每天）。随后是平均2.7年，（标准差1.2）。最初的终结点是致命的活致残的卒中（出血），颅内出血，或有明显临床症状的动脉栓塞。分析倾向于治疗。这个研究注册为国际标准随机对照试验，编号ISRCTN89345269.
Findings
There were 24 primary events (21 strokes, two other intracranial haemorrhages, and one systemic embolus) in people assigned to warfarin and 48 primary events (44 strokes, one other intracranial haemorrhage, and three systemic emboli) in people assigned to aspirin (yearly risk 1•8% vs 3•8%, relative risk 0•48, 95% CI 0•28–0•80, p=0•003; absolute yearly risk reduction 2%, 95% CI 0•7–3•2). Yearly risk of extracranial haemorrhage was 1•4% (warfarin) versus 1•6% (aspirin) (relative risk 0•87, 0•43–1•73; absolute risk reduction 0•2%, −0•7 to 1•2).
结果
分到华法林组的有24个初发事件（21人卒中，两个颅内出血，一个全身性的栓塞），分到阿斯匹林组的有48个初发事件（44人卒中，一人颅内出血，三人全身性的栓塞）（年危险系数为1•8%及 3•8%，相对危险系数0.48，95%趋化指数0.28-0.80，p=0.003；绝对年危险系数年减少2%，95%趋化指数0.7-3.2）。颅外出血的年危险系数为1•4%（华法林）对1•6%（阿斯匹林）（相对危险度0•87，0.43-1.73；绝对危险减少0•2%，-0.7到1.2）
Interpretation
These data support the use of anticoagulation therapy for people aged over 75 who have atrial fibrillation, unless there are contraindications or the patient decides that the benefits are not worth the inconvenience.
解释
这些数据支持使用抗凝结治疗年龄超过75岁的心房颤动患者，除非有禁忌证或病人觉得益处不值带来的不便。( 2007; 370:493-503)