Treatments for Cardiac Conditions

Measures which are effective in reducing the incidence of cardiac disease could lead to a reduction in stroke incidence.

Anti-platelet agents have proven efficacy in the reduction of nonfatal myocardial infarction in primary prevention studies. Beta-blockers have been shown to reduce the risk of myocardial infarction. Warfarin appears beneficial in the prevention of cardiogenic embolism among patients with acute anterior wall myocardial infarction, left atrial or ventricular thrombus, and prosthetic valvular replacements.

Seven recent clinical trials have demonstrated the superior therapeutic effect of warfarin compared to placebo in the prevention of thromboembolic events among patients with nonvalvular atrial fibrillation. The relative risk reduction of stroke ranged from 42% to 86%. Warfarin use was relatively safe with major bleeding rates ranging from 0.8% to 2.1%. These trials also showed that there was a modest risk reduction of stroke among those treated with aspirin. SPAF m demonstrated that warfarin with an INR of 2-3 was far superior to ASA and mini-dose warfarin with an INR < 1.5 in the prevention of stroke among high-risk patients with nonvalvular atrial fibrillation.

The recommendation from the Third American College of Chest Physicians Consensus Conference on Antithrombotic Therapy was that “long-term oral warfarin therapy (INR 2.0-3.0) be User] in patients with atrial fibrillation who are eligible for anticoagulation, except in patients less than 60 years of age who have no associated cardiovascular disease.” It has been estimated that for every 1000 patients with nonvalvular atrial fibrillation treated with warfarin for 1 year, 35 thromboembolic events can be prevented at a cost of 1 major bleed.

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