Is warfarin a safe alternative to aspirin in elderly patients with atrial fibrillation?
We recruited 973 patients (mean age, 81 years) with atrial fibrillation from the primary care setting and randomly assigned them to receive anticoagulation with warfarin or aspirin. We found that the risk of a fatal or disabling stroke (ischemic or hemorrhagic), intracranial hemorrhage, or clinically significant arterial embolism was 50% lower in the group assigned to warfarin compared with those receiving aspirin. The risk of major hemorrhage in both groups was similar. These findings suggest that, in the absence of contraindications, anticoagulation is the treatment of choice for patients who are older than 75 years and have atrial fibrillation.