People over the age of 75 who suffer from atrial fibrillation are better off taking warfarin than aspirin to reduce the risk of stroke, according to an article published in this week's edition of The Lancet.

Dr Jonathan Mant, University of Birmingham, UK and team carried out a study to find out what impact warfarin and aspirin might have on stroke risk - the study was called The Birmingham Atrial Fibrillation Treatment of the Aged Study (BAFTA). They also wanted to know whether the risk of bleeding by using either drug was less than their benefits for elderly patients.

Mant and team examined data on 973 patients, all over 75 years of age. They all suffered from atrial fibrillation. 488 of them were randomly selected to receive warfarin, while the other 485 were given aspirin. They were all followed up for an average of 2.7 years. They studied the incidence of ischaemic or haemorrhagic stroke, intracranial haemorrhage and clinically significant arterial embolism.

-- 24 serious events occurred in the warfarin group. There were 21 strokes, two intracranial haemorrhages, and one systemic embolus.

-- 48 serious events occurred in the aspirin group. There were 44 strokes, one intracranial haemorrhage, and three systemic emboli.

Those taking the warfarin faced a 52% lower risk of suffering a serious event compared to those taking aspirin, said the researchers.

The writers added "We showed that the frequency of stroke, arterial embolism, and intracranial haemorrhage was significantly lower in patients on warfarin than in those on aspirin."

The researchers believe that warfarin could safely be given to more elderly people. "We recorded no evidence that anticoagulants were more hazardous than aspirin therapy in this age group, although the study had limited power to detect those differences."

"BAFTA firmly establishes the superior efficacy of warfarin as a stroke-prevention strategy in elderly patients with atrial fibrillation. However, in the future, our greatest challenge will be to identify those patients (elderly or not) who are truly at the highest risk of major bleeding, particularly intracranial haemorrhage. For everyone else, no matter the age group, the benefits of well-managed warfarin substantially outweigh its risks," Dr David Garcia, University of New Mexico, Albuquerque, USA, wrote in an accompanying Comment.


View drug information on Warfarin Sodium tablets.

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