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Stroke prevention in patients with non-valvular atrial fibrillation

Clinical trials comparing antithrombotic therapy with placebo have shown that Warfarin ( Coumadin ) reduces the risk of stroke by 62%, and that Acetylsalicylic acid ( ASA, Aspirin ) alone reduces the risk by 22%.

In high-risk patients, Warfarin is superior to Acetylsalicylic acid in preventing strokes, with a relative risk reduction of 36%.

Ximelagatran ( Exanta ), an oral direct thrombin inhibitor, was found to be as effective as vitamin K antagonists in the prevention of embolic events, but has been recently withdrawn because of abnormal liver function tests.

The ACTIVE-W ( Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ) study has shown that Warfarin is superior to platelet therapy ( Plavix plus Aspirin ) in the prevention of embolic events.

Angiotensin-converting enzyme inhibitors and angiotensin II receptor-blocking drugs ( sartans ) are promising in atrial fibrillation through cardiac remodelling.

Preliminary studies have shown that statins could interfere with the risk of recurrence of atrial fibrillation after electrical cardioversion.

Source: Expert Opinion on Pharmacotherapy, 2006