SynthesisBMJ (Clinical research ed.)2001
Systematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrial fibrillation.
Synthesis in BMJ (Clinical research ed.), 2001. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 26 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 6 syntheses or guidelines pooled it, 127 citations in OpenAlex.
- Effectiveness and patient safety of platelet aggregation inhibitors in the prevention of cardiovascular disease and ischemic stroke in older adults - a systematic review.BMC geriatrics · 2017Pooled it
- Pooled it
- Guideline
- Guideline
- Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no history of stroke or transient ischemic attacks.The Cochrane database of systematic reviews · 2007Pooled it
- Antithrombotic treatment in atrial fibrillation.Heart (British Cardiac Society) · 2007Guideline
- Pharmacokinetics and safety evaluation of indobufen tablets under fasting and fed conditions in healthy Chinese volunteers.Naunyn-Schmiedeberg's archives of pharmacology · 2026Trial
- Protocol for Birmingham Atrial Fibrillation Treatment of the Aged study (BAFTA): a randomised controlled trial of warfarin versus aspirin for stroke prevention in the management of atrial fibrillation in an elderly primary care population [ISRCTN89345269].BMC cardiovascular disorders · 2003Trial
- Thrombosis prevention trial: follow-up study of practical implications.The British journal of general practice : the journal of the Royal College of General Practitioners · 2002Trial
- Who Needs Gastroprotection in 2020?Current treatment options in gastroenterology · 2020Review
- Review
- Should anticoagulation be resumed after intracerebral hemorrhage?Cleveland Clinic journal of medicine · 2010Review
- Article
- Ten-year experience with acenocoumarol treatment in an ambulatory cohort of Spanish patients.Journal of thrombosis and thrombolysis · 2009Article
- The use of antithrombotics in patients presenting with stroke and atrial fibrillation.Therapeutics and clinical risk management · 2007Article
- [Anticoagulation with atrial fibrillation].Herzschrittmachertherapie & Elektrophysiologie · 2006Review
- Rate-control or rhythm-control: where do we stand?Indian pacing and electrophysiology journal · 2005Article
- Thyrotoxic atrial fibrillation.MedGenMed : Medscape general medicine · 2005Review
- Cognitive impairment as determinant for sub-optimal control of oral anticoagulation treatment in elderly patients with atrial fibrillation.Drugs & aging · 2005Review
- [Anticoagulants for patients with chronic auricular fibrillation: when are they indicated?].Atencion primaria · 2004Article
Corrections and comments
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- Erratum issued
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine the benefits and risks of long term anticoagulation (warfarin) compared with antiplatelet treatment (aspirin/indobufen) [corrected] in patients with non-rheumatic atrial fibrillation.
methodsMeta-analysis of randomised controlled trials from Cochrane library, Medline, Embase, Cinhal, and Sigle from 1966 to December 1999. Odds ratios (95% confidence intervals) calculated to estimate treatment effects. OUTCOME MEASURES: Fatal and non-fatal cardiovascular events, reductions of which were classified as benefits. Fatal and major non-fatal bleeding events classified as risks.
resultsNo trials were found from before 1989. There were five randomised controlled trials published between 1989-99. There were no significant differences in mortality between the two treatment options (fixed effects model: odd ratio 0.74 (95% confidence interval 0.39 to 1.40) for stroke deaths; 0.86 (0.63 to 1.17) for vascular deaths). There was a borderline significant difference in non-fatal stroke in favour of anticoagulation (0.68 (0.46 to 0.99)); and 0.75 (0.50 to 1.13) after exclusion of one trial with weak methodological design. A random effects model showed no significant difference in combined fatal and non-fatal events (odds ratio 0.79 (0.61 to 1.02)). There were more major bleeding events among patients on anticoagulation than on antiplatelet treatment (odds ratio 1.45 (0.93 to 2.27)). One trial was stopped prematurely after a significant difference in favour of anticoagulation was observed. The only trial to show a significant difference in effect (favouring anticoagulation) was methodologically weaker in design than the others.
conclusionsThe heterogeneity between the trials and the limited data result in considerable uncertainty about the value of long term anticoagulation compared with antiplatelet treatment. The risks of bleeding and the higher cost of anticoagulation make it an even less convincing treatment option.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.