Indobufen Versus Warfarin in the Secondary Prevention of Major Vascular Events in Nonrheumatic Atrial Fibrillation

Abstract

We conclude that, within the limitations of its design, this study may help the medical community in devising appropriate antithrombotic strategies for NRAF patients for whom oral anticoagulants are contraindicated or do not represent a feasible approach to treatment.

Prevention of thromboembolism in atrial fibrillation

“…From these, 11 articles were appropriate for inclusion in this meta-analysis, evaluating warfarin versus placebo, [13][14][15][16][17][18] aspirin versus placebo, 15,19,20 warfarin versus aspirin, [20][21][22] warfarin versus aspirin plus low-dose warfarin, 22,23 warfarin versus indobufen, a reversible cyclo-oxygenase inhibitor, 24 and low molecular weight heparin versus placebo. 25 Qualitative Synthesis Study Design.…”

“…All of the studies excluded patients with rheumatic valvular disease, for whom there is strong evidence that anticoagulation is indicated. 26 Importantly, the EAFT trial 19 and the indobufen study 24 were secondary prevention trials (i.e., they enrolled patients who had already had a stroke or transient ischemic attack). Thus, the results of these studies were interpreted separately from the other trials.…”

The risk of myocardial infarction in patients with atrial fibrillation: an unresolved issue

“…A trial was excluded from our analysis if the AF population was lower than 150 subjects. Thus, 13 studies were selected according to the above-mentioned inclusion and exclusion criteria [5][6][7][8][9][10][11][12][13][14][15][16][17] (Table 1). In only two of these, MACE were included as primary end-points [5,6] (Table 1A).…”

“…In these patients of advancing age, male gender, higher systolic blood pressure, history of systemic hypertension, diabetes mellitus and PAD were significant independent predictors of a first MACE. Among the remaining 11 studies [7][8][9][10][11][12][13][14][15][16][17], in which MACE had been recorded during the follow-up, we observed a high variability (Table 1B). In fact, the rate of fatal and non-fatal MI ranged from 0.5 to 4%/year.…”

“…In the six studies in which more than 19% of patients had previous CHD, the average incidence of MI was 6.9% [7][8][9][10][11][12]. In contrast, in the remaining 5 studies in which a clinical history of CHD was detected in \19% of cases, MI occurred significantly less frequently(1.4%; Test for difference between two proportions: P \ 0.0001) [13][14][15][16][17].…”