Harvard Heart Letter

Heart Beat: Warfarin trumps aspirin for stroke prevention in elderly

Heart Beat

Warfarin trumps aspirin for stroke prevention in elderly

Stroke is one of the most feared complications of atrial fibrillation, an extremely common, rapid and erratic rhythm of the heart's upper chambers. Many studies have shown that taking warfarin (Coumadin) helps prevent stroke in people with atrial fibrillation. But some doctors worry that it's too powerful for older people and causes more problems than it prevents. Not so, say researchers who conducted the Birmingham Atrial Fibrillation Treatment of the Aged study in England and Wales. They compared warfarin and low-dose aspirin in men and women over age 75 with atrial fibrillation.

After nearly three years, 1.8% of those in the warfarin group and 3.8% of those in the aspirin group had experienced a fatal stroke, a disabling stroke, or a serious blood clot. Bleeding problems, such as bleeding into the brain and gastrointestinal bleeding, were similar in both groups. Heart attacks and deaths from all causes were also similar. The findings, which were presented at the 16th European Stroke Conference in Glasgow, Scotland, offer some reassurance that warfarin is as effective and safe for older people as it is for younger ones.

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