From: ndallen@r-node.gts.org (Nigel Allen)
Subject: VA Study Demonstrates 79-Percent Reduction in Stroke Risk
Organization: Echo Beach, Toronto
Date: Thu, 12 Nov 1992 23:17:36 GMT

Here is a press release from the U.S> Department of Veterans Affairs.

 VA Study Demonstrates 79-Percent Reduction in Stroke Risk
 To: National Desk, Medical Writers
 Contact: U.S. Department of Veterans Affairs, 202-535-8300

   WASHINGTON, Nov. 11  -- A new national study demonstrates 
that low doses of the anticoagulant warfarin can reduce the risk 
of stroke by 79 percent in patients who suffer from a
common heart irregularity known as atrial fibrillation (AF).
   The 16-site Department of Veterans Affairs (VA) Cooperative Study
will be published in The New England Journal of Medicine Thursday,
Nov. 12.
   More than 1 million Americans are at increased risk of stroke from
atrial fibrillation.  Therapy benefits are greatest for patients over
70 years of age -- those who have the highest incidence of AF.
Results of the study were so conclusive that an independent review
panel halted it one year earlier than the three years projected so
that the control group could also benefit from receiving the
medication.  Preliminary results of the study were released in 1991
in connection with an episode of AF experienced by President Bush.
   Although previous studies have sought to examine treatment methods
to reduce AF-related stroke, the study to be published Nov. 12 --
"Stroke Prevention In Non-Rheumatic Atrial Fibrillation" -- is the
only U.S.-based, double-blind, placebo-controlled trial.  Neither
investigators nor patients were aware of who received the drug.  The
study was funded by the VA Cooperative Studies Program and directed
from the West Haven, Conn., VA Medical Center.
   "The medical community now has conclusive evidence that patients
with chronic AF should be offered warfarin therapy unless there is a
contraindication to treatment," said Principal Investigator
Dr. Michael D. Ezekowitz, chief of cardiology at the West Haven VA
Medical Center and professor of medicine at Yale School of Medicine.
"We achieved a 79-percent reduction in the rate of stroke with
low-dose warfarin.  This included patients over 70 years old."
   A consensus paper, published by the American College of Chest
Physicians in the medical journal Chest, recommends treatment of AF
as the most effective means to minimize the risk of systemic
embolism.  The preliminary study results contributed to development
of these recommendations, which are expected to become standard
practice both in this country and abroad.
   Of the 500,000 stokes reported annually in the United States, some
15 percent -- 75,000 -- are linked to AF; and AF is the single most
important characteristic associated with stroke in patients over 70
years of age.  Stroke remains the nation's third leading killer after
heart disease and cancer, responsible for 145,000 deaths each year.
Stroke is also the leading cause of disability in adults and is
estimated to cost the nation about $25 billion per year in health
care costs and lost wages.
   "We estimate that if patients were routinely treated with
anticoagulant therapy," said Ezekowitz, "the nation could save
$2 billion in stroke-associated costs, as well as avoid the tragic
consequences for patients and their families."
   The study followed 525 patients with the most common type of AF,
known as "non-rheumatic."  During the trial, 260 male patients
received low-dose warfarin and 265 received placebo.  Patients were
followed for an average of almost two years.  During that period,
there were 19 strokes among the placebo-control group during an
average followup of 1.7 years, and four strokes among the warfarin
group during an average followup of 1.8 years.  Overall risk
reduction with warfarin therapy was 79 percent.
   In addition to its efficacy, the medication was found to be safe,
with episodes of major bleeding equally distributed among the
warfarin and placebo groups.  Major hemorrhages, all
gastrointestinal, occurred in 10 patients ages 52 to 94 years (four
placebo, six warfarin).
   The overall death rate, which reflected the patients' advanced
years and included deaths not due to cardiac events, was lower in the
warfarin group than in the control group (22 versus 15).
   "Patients who have AF or who suspect they may have AF should see
their doctors," Ezekowitz urged.  "Many patients with AF report no
symptoms; but those who experience feelings of weakness, palpitations
or shortness of breath should see their physician immediately.  In
many cases, this method of treatment can significantly lower their
risk of stroke."
   AF patients who have been diagnosed, but not treated, can obtain
more information by calling the American College of Chest Physicians,
800-423-1925.
 -30-
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