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  • Title: Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attacks.
    Author: Koudstaal PJ.
    Journal: Cochrane Database Syst Rev; 2000; (2):CD000185. PubMed ID: 10796313.
    Abstract:
    BACKGROUND: People with nonrheumatic atrial fibrillation who have had a transient ischemic attack or a minor ischemic stroke are at risk of recurrent stroke. OBJECTIVES: The objective of this review was to assess the effect of anticoagulants for secondary prevention, after a stroke or transient ischaemic attack, in patients with nonrheumatic atrial fibrillation. SEARCH STRATEGY: The reviewer searched the Cochrane Stroke Group trials register and contacted trialists. SELECTION CRITERIA: Randomised trials comparing oral anticoagulants (target International Normalised Ratio range 2.5 to 4.0) with control or placebo in people with nonrheumatic atrial fibrillation and a previous transient ischaemic attack or minor ischaemic stroke. DATA COLLECTION AND ANALYSIS: One reviewer assessed trial quality and extracted data. MAIN RESULTS: Two trials involving 485 people were included. Anticoagulants reduced the risk of recurrent stroke by two-thirds (odds ratio 0.36, 95% confidence interval 0.22 to 0.58). The risk of all vascular events was shown to be almost halved by treatment (odds ratio 0.55, 95% confidence interval 0.37 to 0.82). No intracranial bleeds were reported among people given anticoagulants. REVIEWER'S CONCLUSIONS: The evidence suggests that anticoagulants are beneficial, without serious adverse effects, for people with nonrheumatic atrial fibrillation and recent cerebral ischaemia.
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