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Comparative effects of antiplatelet, anticoagulant, or combined therapy in patients with valvular and nonvalvular atrial fibrillation

A randomized multicenter study

Francisco Pérez-Gómez, PhD, FESC^*,*, Eduardo Alegría, MD, PhD, Jesus Berjón, MD, PhD, Jose A. Iriarte, MD, PhD, Javier Zumalde, MD^||, Antonio Salvador, MD, PhD^¶, Luis Mataix, MD^# NASPEAF Investigators

^* Hospital Clínico San Carlos, Madrid, Spain
Clínica Universitaria de Navarra, Pamplona, Spain
Hospital de Navarra, Pamplona, Spain
Hospital de Basurto, Bilbao, Spain
^|| Hospital Galdakao, Bilbao, Spain
^¶ Hospital Dr. Peset, Valencia, Spain
^# Centro Especialidades Avenida de Portugal, Madrid, Spain

View larger version (23K): [in a new window]   Figure 1 Flow diagram of the NASPEAF. Lost to follow-up corresponds to those patients about whom no data about efficacy and safety is available. INR = international normalized ratio; ITT = intention to treat; IQR = interquartile range.

View larger version (21K): [in a new window]   Figure 2 Primary outcome Kaplan-Meier survival curves. (A) Intermediate-risk group (nonvalvular atrial fibrillation without embolism at baseline). (B) High-risk group (mitral stenosis with/without embolism and nonvalvular atrial fibrillation with embolism at baseline). N = number at risk; SE = standard error.

View larger version (23K): [in a new window]   Figure 3 Relative effect on vascularevents of combined versus anticoagulant therapy. Log hazard ratio (HR) (95% confidence interval [CI]) = logarithm hazard ratio whose 95% CI (error bars) excludes the vertical line are statistically significant at the 5% level (or significant with p < 0.05). AMI = acute myocardial infarction.

View larger version (27K): [in a new window]   Figure 4 Kaplan-Meier survival curves of the composite embolism-stroke-transient ischemic attack (TIA) in different groups of patients. (A) Survival curves inthe combined therapy and anticoagulant arms of the intermediate- and high-risk groups. (B) Survival curves in groups of patients receiving anticoagulant therapy for INR (2 to 3). ACO = anticoagulant; Emb/embol = embolism; TIA = transient ischemic attack; other abbreviations as in Figure 2.