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Titolo:
WARFARIN VERSUS ASPIRIN FOR PREVENTION OF THROMBOEMBOLISM IN ATRIAL-FIBRILLATION - STROKE PREVENTION IN ATRIAL-FIBRILLATION-II STUDY
Autore:
MCBRIDE R; CHESEBRO JH; WIEBERS DO; HOLLAND AE; LINKER S; BARDSLEY WT; KOPECKY S; LITIN SC; MEISSNER I; ZERBE DM; FLAKER GC; WEBEL R; NOLTE B; STEVENSON P; BYER J; JENKINS JS; WRIGHT W; ANDERSON DC; ASINGER RW; NEWBURG SM; BUNDLIE SR; FARMER CC; KOLLER RL; HAUGLAND JM; NANCE MA; TARREL RM; DUNBAR DN; JORGENSEN CR; SHARKEY SW; LEONARD ADS; KANTER MC; SOLOMON DH; ZABALGOITIA M; MCANULTY JH; MARCHANT C; COULL BM; KELLEY RE; CHAHINE R; PALERMO M; TEIXEIRO P; FELDMAN G; HAYWARD A; MACMILLAN K; GANDARA E; ANDERSON W; BLANK N; STRAUSS R; FEINBERG WM; VOLD BK; KERN KB; APPLETON C; BRUCK D; DORR S; DITTRICH HC; ROTHROCK JF; KERRIDGE C; LOGAN WR; HAMILTON WP; GREEN BJ; BACON RS; HELGASON CM; KONDOS GT; HOFF J; MCRAE RP; HALPERIN JL; ROTHLAUF EB; WEINBERGER JM; GOLDMAN ME; MILLER VT; HOCKERSMITH CJ; COHEN BA; JANOSIK DL; CADELL DJ; KELLERMAN L; GOMEZ CR; LABOVITZ AJ; ROTHBART RM; BAILEY GH; BURKHARDT C; HORWITZ L; BLACKSHEAR JL; WEAVER L; BAKER V; LEE G; LANE G; RUBINO F; SAFFORD R; KRONMAL RA; PEARCE LA; FLETCHER KA; NASCO E; HART RG; SHERMAN DG; TALBERT RL; DACY TL; HERBERLING PA;
Indirizzi:
STAT & EPIDEMIOL RES CORP,1107 NE 45TH ST,SUITE 520 SEATTLE WA 98105 MAYO CLIN & MAYO FDN ROCHESTER MN 00000 UNIV MISSOURI COLUMBIA MO 00000 HENNEPIN CTY MED CTR MINNEAPOLIS MN 00000 ABBOTT NW HOSP MINNEAPOLIS MN 00000 PARK NICOLLET MED CTR MINNEAPOLIS MN 00000 UNIV TEXAS,HLTH SCI CTR SAN ANTONIO TX 00000 AUDIE L MURPHY MEM VET ADM MED CTR SAN ANTONIO TX 78284 OREGON HLTH SCI UNIV PORTLAND OR 97201 UNIV MIAMI,SCH MED MIAMI FL 00000 KAISER PERMANENTE CTR HLTH RES PORTLAND OR 00000 UNIV ARIZONA,COLL MED TUCSON AZ 00000 UNIV CALIF SAN DIEGO,MED CTR SAN DIEGO CA 92103 ST JOHNS MERCY MED CTR ST LOUIS MO 00000 UNIV CHICAGO,COLL MED CHICAGO IL 60637 UNIV ILLINOIS,COLL MED PEORIA IL 61656 MT SINAI MED CTR NEW YORK NY 10029 NORTHWESTERN UNIV,SCH MED CHICAGO IL 00000 ST LOUIS UNIV,MED CTR ST LOUIS MO 00000 UNIV COLORADO,SCH MED DENVER CO 00000 MAYO CLIN JACKSONVILLE FL 00000 UNIV WASHINGTON SEATTLE WA 00000
Titolo Testata:
Lancet
fascicolo: 8899, volume: 343, anno: 1994,
pagine: 687 - 691
SICI:
0140-6736(1994)343:8899<687:WVAFPO>2.0.ZU;2-7
Fonte:
ISI
Lingua:
ENG
Soggetto:
COMPLICATIONS; THERAPY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
20
Recensione:
Indirizzi per estratti:
Citazione:
R. Mcbride et al., "WARFARIN VERSUS ASPIRIN FOR PREVENTION OF THROMBOEMBOLISM IN ATRIAL-FIBRILLATION - STROKE PREVENTION IN ATRIAL-FIBRILLATION-II STUDY", Lancet, 343(8899), 1994, pp. 687-691

Abstract

Warfarin is an established treatment for prevention of ischaemic stroke in patients with atrial fibrillation, but the value of this agent relative to aspirin is unclear. In the first Stroke Prevention in Atrial Fibrillation (SPAF-I) study, direct comparison of warfarin with aspirin was limited by the small number of thromboembolic events. SPAF-II aims to address this issue and also to assess the differential effectsof the two treatments according to age. We compared warfarin (prothrombin time ratio 1.3-1.8, international normalised ratio 2.0-4.5) with aspirin 325 mg daily for prevention of ischaemic stroke and systemic embolism (primary events) in two parallel randomised trials involving 715 patients aged 75 years or less and 385 patients older than 75; we sought reductions in the absolute rate of primary events by warfarin compared with aspirin of 2% per year and 4% per year, respectively. In the younger patients, warfarin decreased the absolute rate of primary events by 0.7% per year (95% Cl - 0.4 to 1.7). The primary event rate per year was 1.3% with warfarin and 1.9% with aspirin (relative risk [RR] 0.67, p = 0.24). The absolute rate of primary events in low-risk younger patients (without hypertension, recent heart failure, or previous thromboembolism) on aspirin was 0.5% per year (95% Cl 0.1 to 1.9). Among older patients, warfarin decreased the absolute rate of primary events by 1.2% per year (95% Cl - 1.7 to 4.1). The primary event rate per year was 3.6% with warfarin and 4.8% with aspirin (RR 0.73, p = 0.39). In this older group, the rate of all stroke with residual deficit (ischaemic or haemorrhagic) was 4.3% per year with aspirin and 4.6% per year with warfarin (RR 1.1). Warfarin may be more effective than aspirin for prevention of ischaemic stroke in patients with atrial fibrillation, but the absolute reduction in stroke rate by warfarin is small. Younger patients without risk factors had a low rate of stroke when treated with aspirin. In older patients the rate of stroke (ischaemic and haemorrhagic) was substantial, irrespective of which agent was given. Patient age and the inherent risk of thromboembolism should be considered in the choice of antithrombotic prophylaxis for patients with atrial fibrillation.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 30/11/20 alle ore 12:41:12