Comparative effects of antiplatelet, anticoagulant, or combined therapy in patients with valvular and nonvalvular atrial fibrillation: a randomized multicenter study
| Autor: | Francisco, Pérez-Gómez, Eduardo, Alegría, Jesus, Berjón, Jose A, Iriarte, Javier, Zumalde, Antonio, Salvador, Luis, Mataix |
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| Rok vydání: | 2004 |
| Předmět: |
Male
Dose-Response Relationship Drug Acenocoumarol Embolism Anticoagulants Hemorrhage Middle Aged Survival Analysis Salicylates Treatment Outcome Intracranial Embolism Cause of Death Atrial Fibrillation Humans Mitral Valve Stenosis Drug Therapy Combination Female International Normalized Ratio Platelet Aggregation Inhibitors Aged Follow-Up Studies Proportional Hazards Models |
| Zdroj: | Journal of the American College of Cardiology. 44(8) |
| ISSN: | 0735-1097 |
| Popis: | This trial evaluated the efficacy and safety of the combination of antiplatelet and moderate-intensity anticoagulation therapy in patients with atrial fibrillation associated with recognized risk factors or mitral stenosis.Warfarin was more effective than aspirin in preventing stroke in these patients; combined therapy with low anticoagulant intensity was ineffective. Mitral stenosis patients were not investigated.We performed a multicenter randomized trial in 1,209 patients at risk. The intermediate-risk group included patients with risk factors or age60 years: 242 received the cyclooxygenase inhibitor triflusal, 237 received acenocumarol, and 235 received a combination of both. The high-risk group included patients with prior embolism or mitral stenosis: 259 received anticoagulants and 236 received the combined therapy. Median follow-up was 2.76 years. Primary outcome was a composite of vascular death and nonfatal stroke or systemic embolism.Primary outcome was lower in the combined therapy than in the anticoagulant arm in both the intermediate- (hazard ratio [HR] 0.33 [95% confidence interval (CI)0.12 to 0.91]; p = 0.02) and the high-risk group (HR 0.51 [95% CI 0.27 to 0.96]; p = 0.03). Primary outcome plus severe bleeding was lower with combined therapy in the intermediate-risk group. Nonvalvular and mitral stenosis patients had similar embolic event rates during anticoagulant therapy.The combined antiplatelet plus moderate-intensity anticoagulation therapy significantly decreased the vascular events compared with anticoagulation alone and proved to be safe in atrial fibrillation patients. |
| Databáze: | OpenAIRE |
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