A recent multicenter study showed that warfarin (Coumadin) was better than aspirin 75 mg daily for the prevention of stroke (Lancet. 2007;370:493-503). About 12 years ago, I heard a presentation in which Coumadin compared with two 325-mg aspirin per day had a better stroke rate but a little higher hemorrhage rate, resulting in virtually identical total adverse event rates. Needless to say, I am a fan of aspirin therapy, but I use higher doses than currently recommended.
—Clinton Faber, MD, Reedsport, Ore.
The Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) study referred to by Dr. Faber compared the use of aspirin and warfarin in the treatment of elderly patients, i.e., older than 75 years, who had chronic, nonvalvular, atrial fibrillation. The number of adverse events (primarily strokes) was significantly higher in the aspirin-treated group while the rate of complications, including intracranial hemorrhages, was equivalent. This study confirms the long-standing recommendation for the treatment of chronic, nonvalvular atrial fibrillation with warfarin. Careful, systematic, regular monitoring is essential when using warfarin.
Aspirin with or without a secondary antiplatelet agent (dipyridamole) remains the treatment of choice for stroke prevention in the absence of atrial fibrillation.
—Jay E. Selman, MD (121-11)