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Data from clinical trials performed before 2000 form the basis for the recommendation that anticoagulant therapy be prescribed to prevent ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF). Adherence to this recommendation has been spotty, primarily because of concerns about anticoagulant-associated bleeding and also because maintaining therapeutic levels of warfarin is difficult. Consequently, substituting easier-to-manage antiplatelet agents (such as aspirin) or novel anticoagulants for warfarin has generated interest. Some 13 randomized trials addressing this issue have been conducted in recent years.
In a new meta-analysis, university investigators evaluated 29 randomized trials (mean follow-up, 1.5 years/patient) th…