PT  - JOURNAL ARTICLE
AU  - Trang Dinh
AU  - Leo H B Baur
AU  - Ron Pisters
AU  - Otto Kamp
AU  - Freek W A Verheugt
AU  - Joep L R M Smeets
AU  - Emile C Cheriex
AU  - Jan-Eize Lindeboom
AU  - Wilfred F Heesen
AU  - Robert G Tieleman
AU  - Martin H Prins
AU  - Harry J G M Crijns
AU  - for the TIARA investigators
TI  - Aspirin versus vitamin K antagonist treatment guided by transoesophageal echocardiography in patients with atrial fibrillation: a pilot study
AID  - 10.1136/heartjnl-2013-305017
DP  - 2014 Apr 01
TA  - Heart
PG  - 563--568
VI  - 100
IP  - 7
4099  - http://heart.bmj.com/content/100/7/563.short
4100  - http://heart.bmj.com/content/100/7/563.full
SO  - Heart2014 Apr 01; 100
AB  - Objective Current stroke risk schemes need improvement of predictive value in patients with atrial fibrillation. Transoesophageal echocardiography (TEE) may facilitate stroke risk assessment in such patients and guide antithrombotic treatment. Methods We randomised 238 patients with non-valvular atrial fibrillation and a moderate stroke risk to aspirin or adjusted vitamin K antagonist therapy after TEE had ruled out thrombogenic features in the atria and aorta. The primary outcome was a composite of stroke, major bleeding, peripheral embolism and all-cause mortality. Results Mean CHA2DS2-VASc score was 2.1±1.1. The incidences of the composite primary outcome at a mean follow-up of 1.6 years were 3.2% (2.02% per year) in the aspirin group compared to 6.1% (3.84% per year) in the vitamin K antagonists group with an absolute advantage of 2.9 percentage points. Aspirin was non-inferior to vitamin K antagonists (p<0.0001) because the upper limit of the 90% CI did not exceed the 7% absolute difference in event rate between the two treatment arms. Conclusions This hypothesis-generating pilot trial has found that TEE may be used for refinement of stroke risk in paroxysmal atrial fibrillation patients. A larger trial is needed to confirm these data. (ClinicalTrials.gov number NTC00224757).