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Adjusted-dose warfarin is highly efficacious for prevention of ischaemic stroke in patients with atrial fibrillation (AF). However, this treatment carries a risk of bleeding and the need for frequent medical monitoring. We sought an alternative that would be safer and easier to administer to patients with AF who are at high-risk of thromboembolism.

1044 patients with AF and with at least one thromboembolic risk factor (congestive heart failure or left ventricular fractional shortening ≤25%, previous thromboembolism, systolic blood pressure of more than 160 mm Hg at study enrolment, or being a woman aged over 75 years) were randomly assigned either a combination of low-intensity, fixed-dose warfarin (international normalised ratio [INR] 1·2–1·5 for initial dose adjustment) and aspirin (325 mg/day) or adjusted-dose warfarin (INR 2·0–3·0). Drugs were given open-labelled.

The …