WARFARIN PREFERABLE TO ASPIRIN AND CLOPIDOGREL FOR PREVENTING STROKE IN WARFARIN INELIGIBLE PATIENTS WITH ATRIAL FIBRILLATION
WARFARIN PREFERABLE TO ASPIRIN AND CLOPIDOGREL FOR PREVENTING STROKE IN WARFARIN INELIGIBLE PATIENTS WITH ATRIAL FIBRILLATION
New Study Compares Results from ACTIVE-A and ACTIVE-W trials
BEIJING, 18 JUNE 2010. Warfarin is the preferred treatment option for patients with atrial fibrillation (AF) that have previously been considered to be both eligible and ineligible for warfarin treatment, according to data presented today at the World Congress of Cardiology (WCC) Scientific Sessions in Beijing, China.
Results from two trials - ACTIVE-A and ACTIVE-W - were compared to determine the relative effects of aspirin; aspirin and clopidogrel (A+C); and warfarin on stroke rates and safety in patients with atrial fibrillation that had been determined to be both eligible and ineligible for warfarin treatment. Across the two studies, comprising four treatment groups (Active-A - Aspirin and A+C groups; Active-W - A+C and warfarin groups), the total stroke rate in the warfarin group was significantly lower at only 1.4 per cent per year than in any of the other groups. Moreover, bleeding rates were comparable across the A+C groups in both trials and the warfarin group.
Table: Comparison of the ACTIVE-A and ACTIVE-W trials
| ACTIVE-A<//u><//u> | ACTIVE-W<//u><//u> | |||
| Aspirin(n=3,782) | A+C (n=3,772) | A+C (n=3,335) | Warfarin (n=3,371) | |
| Total strokes (%/y) | 3.3 | 2.4 | 2.4 | 1.4 |
| Disabling & fatal strokes (%/y) | 2.1 | 1.6 | 1.7 | 1.3 |
| Major bleeding (%/y) | 1.3 | 2.0 | 2.4 | 2.2 |
| Net clinical benefit | - | + | + | ++ |
“These results suggest that perceived bleeding risk per se does not make AF patients ineligible for warfarin,” said Dr Freek WA Verheugt, Chair of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands. “Thus, warfarin should remain the cornerstone for stroke prevention in all AF patients with a CHADS2 score >1.”
In ACTIVE-W patients eligible for warfarin (n=6,706) were randomized to warfarin or A+C and followed for 1.8 year (y) when the trial was stopped prematurely. Patients ineligible for warfarin (n=7,554) were randomized in ACTIVE-A to A+C or aspirin alone and followed for 3.6 y. Clopidogrel dose was 75 mg and aspirin dose 75-100 mg daily in both trials.
About the World Congress of Cardiology
The World Congress of Cardiology Scientific Sessions is the official congress of the World Heart Federation and is held every two years. Through the Congress the World Heart Federation offers an international stage for the latest developments in science and public outreach in the field of cardiovascular health. The World Congress of Cardiology places emphasis on the complementary nature of science and public outreach and strives to spread the message that through individual, community and patient-care interventions, the growing epidemic of cardiovascular diseases can be prevented. www.worldcardiocongress.org
About the World Heart Federation
The World Heart Federation is dedicated to leading the global fight against heart disease and stroke with a focus on low- and middle-income countries via a united community of more than 200 member organizations. With its members, the World Heart Federation works to build global commitment to addressing cardiovascular health at the policy level, generates and exchanges ideas, shares best practice, advances scientific knowledge and promotes knowledge transfer to tackle cardiovascular disease – the world’s number one killer. It is a growing membership organization that brings together the strength of medical societies and heart foundations from more than 100 countries. Through our collective efforts we can help people all over the world to lead longer and better heart-healthy lives. For more information, please visit www.worldheart.org