Singer D E, Hughes R A, Gress D R, Sheehan M A, Oertel L B, Maraventano S W, Blewett D R, Rosner B, Kistler J P
General Internal Medicine Unit, Massachusetts General Hospital, Boston 02114.
Am Heart J. 1992 Dec;124(6):1567-73. doi: 10.1016/0002-8703(92)90074-6.
Recent randomized trials have consistently demonstrated the marked efficacy of warfarin in reducing the risk of stroke caused by nonrheumatic atrial fibrillation. These trials have provided conflicting evidence on the effect of aspirin. We report the aspirin analysis from the BAATAF study, a trial in which control patients could choose to take aspirin. There we two strokes in 446 person-years with warfarin (annual rate of 0.45%); eight strokes in 206 person-years with aspirin, most at 325 mg per day (annual rate of 3.9%); and five strokes in 271 person-years among patients taking neither aspirin nor warfarin (annual rate of 1.8%). Simultaneously controlling for the other significant determinants of stroke in the BAATAF study (age, mitral annular calcification, and clinical heart disease), the relative rates (95% confidence interval) of stroke were: (1) warfarin/aspirin = 0.135 (0.029 to 0.64); (2) aspirin/(no aspirin and no warfarin) = 1.95 (0.64 to 5.97); and (3) warfarin/(no aspirin and no warfarin) = 0.263 (0.051 to 1.36). Our "treatment received" analysis argues that warfarin is strikingly more effective than aspirin in preventing stroke in nonrheumatic atrial fibrillation.
近期的随机试验一致证明华法林在降低非风湿性心房颤动所致中风风险方面具有显著疗效。这些试验关于阿司匹林的效果提供了相互矛盾的证据。我们报告了BAATAF研究中的阿司匹林分析情况，在该试验中，对照患者可选择服用阿司匹林。服用华法林的446人年中有2例中风（年发生率0.45%）；服用阿司匹林（大多为每日325毫克）的206人年中有8例中风（年发生率3.9%）；既未服用阿司匹林也未服用华法林的患者271人年中有5例中风（年发生率1.8%）。在BAATAF研究中同时对中风的其他重要决定因素（年龄、二尖瓣环钙化和临床心脏病）进行控制后，中风的相对发生率（95%置信区间）如下：（1）华法林/阿司匹林 = 0.135（0.029至0.64）；（2）阿司匹林/（未服用阿司匹林且未服用华法林） = 1.95（0.64至5.97）；（3）华法林/（未服用阿司匹林且未服用华法林） = 0.263（0.051至1.36）。我们的“接受治疗”分析表明，在预防非风湿性心房颤动患者中风方面，华法林比阿司匹林明显更有效。
