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(Stroke. 2008;39:258.)
© 2008 American Heart Association, Inc.

Advances in Stroke 2007

Advances in Prevention and Health Services Delivery 2007

From the Department of Medicine (Neurology) (L.B.G.), Duke Center for Cerebrovascular Disease, Center for Clinical Health Policy Research, Duke University and Veterans Administration Medical Center, Durham, NC, USA; and the Stroke Prevention Research Unit (P.M.R.), University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK.

Correspondence to Larry B. Goldstein, MD, Box 3651, Duke University Medical Center, Durham, NC 27710. E-mail golds004@mc.duke.edu

Key Words: health care • health services delivery • prevention

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The last year has seen advances in both primary and secondary prevention of stroke, including significant steps forward in our understanding of the risks and benefits of anticoagulation in nonvalvular atrial fibrillation (AF) and in assessment of the benefits of urgent treatment after transient ischemic attack (TIA) and minor stroke.

Nonvalvular AF affects about 1% of the population with its prevalence increasing sharply with age. AF is associated with a 5-fold increase in stroke risk.¹ Although warfarin is effective in the secondary prevention of ischemic stroke in the majority of patients with nonvalvular AF,² uncertainties remain about the optimal use of warfarin in routine clinical practice in the primary prevention setting. Research published in 2007 helps to resolve several outstanding questions.

A systematic review analyzed the efficacy and safety of antithrombotic agents in the primary prevention of stroke in patients with nonvalvular AF.³ This review added 13 recent randomized trials to a previous meta-analysis of all published trials with a mean follow-up of 3 months or longer. Compared with the control, adjusted-dose warfarin (6 trials, 2900 participants) reduced stroke by 64% (95% CI, 49 to 74), whereas antiplatelet agents (8 trials, 4876 participants) reduced risk by 22% (95% CI, 6 to 35). Adjusted-dose warfarin was substantially more efficacious than antiplatelet therapy (12 trials, 12 963 participants; relative risk reduction 39%; 95% CI, 22 to 52). Absolute increases in major extracranial hemorrhages were small (0.3% per year). Thus, warfarin was substantially more efficacious than antiplatelet therapy.

Because the absolute risk . . . [Full Text of this Article]