Effect of antithrombotic therapy in patients with mitral stenosis and atrial fibrillation: a sub-analysis of NASPEAF randomized trial
| Autor: | Antonio Salvador, Javier Zumalde, Cristina Fernández, Ramón Bover, Jesus Berjón, Eduardo Alegría, Dionisio Herrera, Jose A. Iriarte, Francisco Pérez-Gómez, Carlos Almería |
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| Rok vydání: | 2005 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_class Embolism Myocardial Infarction Hemorrhage Sudden death Fibrinolytic Agents Risk Factors Internal medicine Atrial Fibrillation medicine Humans Mitral Valve Stenosis cardiovascular diseases Myocardial infarction Stroke Aged business.industry Anticoagulant Hazard ratio Anticoagulants Atrial fibrillation medicine.disease Surgery Drug Combinations Stenosis Death Sudden Cardiac Treatment Outcome cardiovascular system Cardiology Female Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors |
| Zdroj: | European Heart Journal. 27:960-967 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehi667 |
| Popis: | Aims The randomized NASPEAF study included non-valvular with prior embolism and mitral stenosis patients in the same group. This is a sub-study to specially focus on the antithrombotic therapy in mitral stenosis. Methods and results We analysed 311 patients with mitral stenosis, compared with 175 non-valvular atrial fibrillation patients with prior embolism, stratified by a history of previous embolism and assigned to anticoagulant therapy [target international normalized ratio (INR)=2.0–3.0] or combined antiplatelet plus moderate intensity anticoagulant therapy. Median follow-up was 2.9 years. Outcomes were fatal and non-fatal embolism, stroke and myocardial infarction, sudden death, and death from bleeding. Combined therapy in mitral stenosis patients, compared with anticoagulant alone therapy, reduced the risk of vascular events by 58.3%. During equal therapy, the outcome annual rates were essentially the same in non-valvular and valvular patients [hazard ratio 0.90 (95% confidence interval 0.37–2.16), P =0.81]. During anticoagulant alone therapy, the annual event rate in mitral stenosis patients without prior embolism was low (2.5%) and it was very high in patients with prior embolism (6.6%). Conclusion Combined therapy was effective in mitral stenosis patients. Prior embolism patients are not efficiently protected with anticoagulant alone therapy for an INR of 2.0–3.0. |
| Databáze: | OpenAIRE |
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