Canadian Atrial Fibrillation Anticoagulation (CAFA) Study

Hamilton General Hospital, Ontario, Canada.

The Canadian Atrial Fibrillation Anticoagulation Study was a randomized double-blind placebo-controlled trial to assess the potential of warfarin to reduce systemic thromboembolism and its inherent risk of hemorrhage. As a result of the publication of two other "positive" studies of similar design and objective, this study was stopped early before completion of its planned recruitment of 630 patients. There were 187 patients randomized to warfarin and 191 to placebo. Permanent discontinuation of study medication occurred in 26% of warfarin-treated and 23% of placebo-treated patients. The target range of the international normalized ratio was 2 to 3. For the warfarin-treated patients, the international normalized ratio was in the target range 43.7% of the study days, above it 16.6% of the study days and below it 39.6% of the study days. Fatal or major bleeding occurred at annual rates of 2.5% in warfarin-treated and 0.5% in placebo-treated patients. Minor bleeding occurred in 16% of patients receiving warfarin and 9% receiving placebo. The primary outcome event cluster was nonlacunar stroke, noncentral nervous systemic embolism and fatal or intracranial hemorrhage. Events were included in the primary analysis of efficacy if they occurred within 28 days of permanent discontinuation of the study medication. The annual rates of the primary outcome event cluster were 3.5% in warfarin-treated and 5.2% in placebo-treated patients, with a relative risk reduction of 37% (95% confidence limits, -63.5%, 75.5%, p = 0.17).(ABSTRACT TRUNCATED AT 250 WORDS)

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				G.Q. Villani, M. Piepoli, P.E. Villani, and A. Capucci Anticoagulation in atrial fibrillation: what is certain and what is to come Eur. Heart J. Suppl., September 1, 2003; 5(suppl_H): H45 - H50. [Abstract] [PDF]

				W. A. Wattigney, G. A. Mensah, and J. B. Croft Increasing Trends in Hospitalization for Atrial Fibrillation in the United States, 1985 Through 1999: Implications for Primary Prevention Circulation, August 12, 2003; 108(6): 711 - 716. [Abstract] [Full Text] [PDF]

				J. A. Johnston, R. J. Cluxton Jr, P. C. Heaton, J. J. Guo, C. J. Moomaw, and M. H. Eckman Predictors of Warfarin Use Among Ohio Medicaid Patients With New-Onset Nonvalvular Atrial Fibrillation Arch Intern Med, July 28, 2003; 163(14): 1705 - 1710. [Abstract] [Full Text] [PDF]

				P. Petersen, M. Grind, J. Adler, and SPORTIF II Investigators Ximelagatran versus warfarin forstroke prevention in patientswith nonvalvular atrial fibrillation: SPORTIF ii: a dose-guiding, tolerability, and safety study J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1445 - 1451. [Abstract] [Full Text] [PDF]

				J. Hirsh, V. Fuster, J. Ansell, and J. L. Halperin American Heart Association/American College of Cardiology Foundation guide to warfarin therapy J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1633 - 1652. [Full Text] [PDF]

				J. Hirsh, V. Fuster, J. Ansell, and J. L. Halperin American Heart Association/American College of Cardiology Foundation Guide to Warfarin Therapy Circulation, April 1, 2003; 107(12): 1692 - 1711. [Full Text] [PDF]

				S. H. Rahimtoola Choice of prosthetic heart valve for adult patients J. Am. Coll. Cardiol., March 19, 2003; 41(6): 893 - 904. [Abstract] [Full Text] [PDF]

				C. van Walraven, R. G. Hart, D. E. Singer, A. Laupacis, S. Connolly, P. Petersen, P. J. Koudstaal, Y. Chang, and B. Hellemons Oral Anticoagulants vs Aspirin in Nonvalvular Atrial Fibrillation: An Individual Patient Meta-analysis JAMA, November 20, 2002; 288(19): 2441 - 2448. [Abstract] [Full Text] [PDF]

				M. Wakita, M. Yasaka, K. Minematsu, and T. Yamaguchi Effects of Anticoagulation on Infarct Size and Clinical Outcome in Acute Cardioembolic Stroke Angiology, September 1, 2002; 53(5): 551 - 556. [Abstract] [PDF]

				Y. Guang, C. Zhen-jie, L. Wei Yong, L. Tong, and L. Ying Evaluation of clinical treatment of atrial fibrillation associated with rheumatic mitral valve disease by radiofrequency ablation Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 249 - 254. [Abstract] [Full Text] [PDF]

				B. J. Maron, I. Olivotto, P. Bellone, M. R. Conte, F. Cecchi, B. P. Flygenring, S. A. Casey, T. E. Gohman, S. Bongioanni, and P. Spirito Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy J. Am. Coll. Cardiol., January 16, 2002; 39(2): 301 - 307. [Abstract] [Full Text] [PDF]

				A. Evans, I. Perez, G. Yu, and L. Kalra Should Stroke Subtype Influence Anticoagulation Decisions to Prevent Recurrence in Stroke Patients With Atrial Fibrillation? Stroke, December 1, 2001; 32(12): 2828 - 2832. [Abstract] [Full Text] [PDF]

				D. McCormick, J. H. Gurwitz, R. J. Goldberg, R. Becker, J. P. Tate, A. Elwell, and M. J. Radford Prevalence and Quality of Warfarin Use for Patients With Atrial Fibrillation in the Long-term Care Setting Arch Intern Med, November 12, 2001; 161(20): 2458 - 2463. [Abstract] [Full Text] [PDF]

				Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923. [PDF]

				V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1266 - 1266. [Full Text] [PDF]

				C. Wehinger, C. Stollberger, T. Langer, B. Schneider, and J. Finsterer Evaluation of Risk Factors for Stroke/Embolism and of Complications Due to Anticoagulant Therapy in Atrial Fibrillation Stroke, October 1, 2001; 32(10): 2246 - 2252. [Abstract] [Full Text] [PDF]

				M. Copland, I. D. Walker, and R. C. Tait Oral Anticoagulation and Hemorrhagic Complications in an Elderly Population With Atrial Fibrillation Arch Intern Med, September 24, 2001; 161(17): 2125 - 2128. [Abstract] [Full Text] [PDF]