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Titolo:
RANDOMIZED DOUBLE-BLIND TRIAL OF FIXED LOW-DOSE WARFARIN WITH ASPIRINAFTER MYOCARDIAL-INFARCTION
Autore:
FUSTER V; CALIFF RM; CHESEBRO JH; COHEN M; COMP PC; GHEORGHIADE M; HALL J; HALPERIN J; KHAN S; KOPECKY S; LANGER A; MOLK B; MOSS A; OCONNOR CM; OGARA PT; RASKOB E; SUTTON J; BRAUNWALD E; BELL WR; FURBERG C; RAPAPORT E; DEMETS D; GOLDSTEIN S; RICHARDSON D; HILLIS D; BONOW R; KISTLER JP; MOHR JP; SHERMAN D; FISHER M; FEYZI J; COOK T; CALIFF RM; HARRINGTON RA; BERKOWITZ SD; JETT L; BERDAN L; MCDOUGAL M; FRIEDMAN E; DANIEL J; RONCSKEVITZ E; HWANG S; CROWELL D; PAGANINI M; ANDAHL L; OCONNOR C; LUCAS K; COLLINS GJ; MARK RJ; SIEGEL RM; KOEHNEMANN G; GREER S; SCHWEITZER AC; LAWRENCE JE; ALLEN SM; WISEMAN AH; WARWICK DJ; BENNETT WT; SIMMONS K; SHEIKH KH; HENGERER T; CAMPBELL PT; PATTERSON JT; BATES M; MATHEWS A; ROARK SF; MARQUIS N; GOLDNER DB; BROWN G; PARKER JP; WELLS CB; MCGREW FA; HAMILTON B; CARNEY RJ; CRISPIN S; CUMMINS FE; NONNWEILER JM; COLLINS GV; HATHAWAY J; CONN E; MCWILLIAMS C; GEROGE JM; RONCEVICH T; REEVES BR; DINSMORE N; BENDER R; DEROSA K; OCONNOR CM; HOFFMAN S; WERTHEIMER J; TURNER S; CRANDALL CW; HIGGINS DL; BERGER BC; PALAZZO D; FONTANET H; FORD E; CHU AA; PIERSON M; SEAWORTH JF; JENSEN J; HOCHE JP; FORD EA; GOODFIELD P; SPROWLS H; SCHMIDT PJ; NESS C; ODONNELL G; MCNAMEE S; KOREN MJ; BAKER J; HASSEL CD; HARTLEY D; UNKS M; RODGERS K; MUHLESTEIN JB; ALLEN A; SACCHI TJ; MAJOR A; KMONICEK JM; SHANE JW; GOULAH RD; HARNER R; BANNON PJ; HEYL AE; WALL TC; MILKS S; RAMO BW; HEIMGARTNER K; VRANIAN RB; LOUDER DR; STACK RK; JACKSON LL; BERMAN EJ; HAWKINS D; AYCOCK GR; WILCOX T; WEST SR; FOWLER P; ALAGONA P; MOORE A; HINES J; MINOR JR; KEREIAKES DJ; MARTIN LH; FRID DJ; HOMAN JA; BURKS JM; KIRBY JC; PUMA J; JONES L; SCHNEIDER RM; LYTTLE B; TALLEY JD; ASHCRAFT S; JOSEPH A; CORUMHARTLY J; MCNEER JF; LADEN DL; BELKIN RN; WILLIAMSON J; LANGER A; HILL C; BUTTOO K; KACHRA A; LANGER G; KAVANNAUGH L; SHRIVES DM; STRAUSS H; ANDERSON P; KWOK K; KERN C; CHEUNG MT; NAWROCKI H; DARCEL IC; ALI N; CAMPBELL D; SLUZAR V; HINK H; LAM J; MARQUIS J; PARKER JD; WILSON J; JAMES R; NOLF B; ZAWADOWSKI A; BHARGAVA R; GUPTA M; SEVITT B; FITZSIMONS J; BURKE BR; CHOMYC R; SINGH N; BOZEK B; ROTH SL; SMITH J; FELL DA; WILLOUGHY L; RANGANATHAN N; NAWROCKI H; LANGER A; HILL C; MORGAN C; BALLEZA L; SASSON Z; NOLF B; LENKEIKERWIN S; WILSON J; MCALISTER NH; KARHRA N; GANGBAR E; WILLOUGHBY L; HESS A; GAUDET M; BHESANIA T; BURGE D; OGARA P; HAGGAN C; GIBSON M; SLATER A; STONE PH; CLEMENTE C; POLANSKY BJ; CLEMENTS PJ; SCHAEL F; MCGOUGH E; DAUM RM; CAREY G; GILLAM LD; HALL DJ; VENDITTI FJ; WOODHEAD G; BIRKHEAD RG; MCCONNELL D; JANG IK; HAGGAN C; SADANIANTZ A; STAPLES E; WEINSHEL AJ; WEINSHEL G; COHEN M; SHERWOOD J; PALABRICA T; BROWN AM; HACK TC; PAVAO F; MCKENDALL FR; WHEELER JL; GAUGHAN C; MEDICI SE; LOSORDO DW; HALLETTE N; WALDMAN H; CRIASIA M; BATTLE R; ROWEN M; KLEIN ME; HANKIN B; RADFORD MJ; KEARNEY L; BECKER RC; BALL SP; SHARMA GVRK; LAPSLEY DP; WATROUS BG; STANTON A; KOPECKY S; HOLLAND A; SHELHAMER L; GUDMONSON K; BASU HN; BRICKMAN D; RAMEE SR; LANDRY KJ; HELTNE CE; BERGAL LA; LYONS RM; BUSSEY HI; ASINGER R; FIFIELD JH; BRUNS DL; GADIENT L; KINCAID D; BERG S; STORVICK E; WESTPHAL D; REZKALLA SH; WHITE E; SAFFORD RE; DOUCETTE K; COOKMAN JJ; FANGMAN L; ANDERSON BJ; SWAN M; KOUBA C; THEIGE T; VACEK JL; NOLTE B; HURLEY DV; KASKIE K; GARD JR; HARRE SJ; SOLBERG L; MILLER K; MILLER RR; RICKARDS J; YAWN RA; KURLAND M; HAUGLAND JM; SLIVKEN R; HESSION WT; STRUM S; STOWERS SA; ABUAN T; DEWOOD MA; REINHARDT S; KOPECKY SL; RICHARDSON D; ISELE R; BLOCK C; SWENSON LJ; VITTUM KA; WEEKS G; BRENNAN M; CHAPMAN D; THOMMORGAN J; CHELLIAH N; CARTER D; FRIEDMAN B; HAFFEY K; WEBEL R; ROOD M; ANDREWS TC; JULY ME; EDIN AE; HESTER TS; SUTTON J; MCCOLLOUGH T; SCHULMAN D; DELOPLAINE K; BESLEY D; DUNN S; RICHARDS F; SHIPMAN D; JOSEPHSON RA; JASSO D; FLEISCHER L; LOFRANO S; SPRIGGS D; WAHL S; FONT VE; TROTTIER M; SUTTON J; DELUCA SA; SCHWARZ EF; BECKHAM T; MICKOLICH JR; SNYDER M; LANGHOLZ D; JOHNSON E; BEAVER BB; TEDRICK R; BOYD JJ; PROBST P; BEAR PA; CRAIG MB; BLUMENTHAL RS; CARNES T; VILLA AE; ATKINS F; STORER WQ; PAYNE MA; ODONNELL MJ; PROCHNOW L; YAKUBOV S; NOETHEN A; GONZALEZ M; JOPPERI E; JOYCE D; MISHAK S; REEN BM; WHISNANT DR; GACIOCH GM; CHIODO V; EFFRON MB; UTLEY K; FRANK S; DANKOSKI C; KRAUTHAMER D; WELCOM GT; AGUIRRE FV; STONNER T; CANNON L; HARRIS M; BROWN DL; MOEHUFFORD K; HATTEMER CR; HOWARD W; GILMORE PS; WOFFORD R; BATES ER; ALEXANDRIS C; MCCLURE JM; DINNINGER J; MOLK B; DANHOUR G; PACHECO JP; LONGO JA; MOLK BL; BICKETT K; BAUM RS; JENKINS R; BROCKINGTON L; HARDING C; LUCKASEN GJ; RAYDER K; PTASNIK MJ; HARDING C; BRACHFELD CA; VINCZE T; CADIGAN RA; WUBBENA BA; SMITH BR; ONEILL D; PACHELO GM; GODFREY CC; FECIK C; LARSON D; RAYDER K; BACKUP LD; DRAKE Z; MIKLIN JS; ARIS G; SCHWARTZ DJ; STARK S; SMITH S; EASTBURN T; MARSH R; LORENZ S; THOMPSON R; KLEINMAN J; ARIS G; BRECKINRIDGE JC; DAUBER IM; BELL W; VANBENTHUYSEN K; PREVEDEL J; FECIK C; STRINGER KA; WHITEROCK A; LEVITT PW; PETRAS J; COHEN M; STOAKES K; DANIELS S; STERNBERG C; MAZUZ M; FRYMOYER BS; DICKSTEIN RA; BANGER D; KRAMER JH; EVANS C; VICTOR M; LUHMANN S; WORLEY WJ; TUZI J; JANZER SF; LYSGAARD JK; STILLABOWER ME; DISABATINO A; VOYCE S; KEATING D; COHEN M; STOAKES K; ZAKRZEWSKI M; HAYES C; OWENS JS; AMBURG C; ZATUCHNI J; BOYLE M; GHEORGHIADE M; MISTOVICH M; ZAYAC J; DEGIROLAMI D; PETERSON D; GLICK G; REDA A; HUETER D; WESZT S; WYNNE J; LADD DF; MATHEW J; DAVIDSON S; BORZAK S; CRUZ TA; CHIU C; SEDLARZ P; SHANES JG; CALKINS M; ALEXANDER J;
Indirizzi:
MT SINAI HOSP,BOX 1030,1 GUSTAVE LEVY PL NEW YORK NY 10029 UNIV WISCONSIN,DATA ANAL CTR MADISON WI 53706 COUMADIN ASPIRIN REINFARCT STUDY ORG,WRITING & STEERING COMM NEW YORKNY 10029 COUMADIN ASPIRIN REINFARCH STUDY ORG,DATA & SAFETY MONITORING COMM NEW YORK NY 10029 COUMADIN ASPIRIN REINFARCT STUDY ORG,EVENTS CLASSIFICAT COMM NEW YORKNY 10029 DUKE UNIV,COORDINATING CTR DURHAM NC 27706 SMITHKLINE BEECHAM CLIN LABS,CENT INR LAB PISCATAWAY NJ 00000
Titolo Testata:
Lancet
fascicolo: 9075, volume: 350, anno: 1997,
pagine: 389 - 396
SICI:
0140-6736(1997)350:9075<389:RDTOFL>2.0.ZU;2-H
Fonte:
ISI
Lingua:
ENG
Soggetto:
ISCHEMIC-HEART-DISEASE; PRIMARY PREVENTION; VALVE REPLACEMENT; CLINICAL-TRIALS; HIGH-RISK; THERAPY; REINFARCTION; ACTIVATION; MORTALITY; ANGINA;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
31
Recensione:
Indirizzi per estratti:
Citazione:
V. Fuster et al., "RANDOMIZED DOUBLE-BLIND TRIAL OF FIXED LOW-DOSE WARFARIN WITH ASPIRINAFTER MYOCARDIAL-INFARCTION", Lancet, 350(9075), 1997, pp. 389-396

Abstract

Background Antiplatelet therapy with aspirin and systematic anticoagulation with warfarin reduce cardiovascular morbidity and mortality after myocardial infarction when given alone. In the Coumadin Aspirin Reinfarction Study (CARS), we aimed to find out whether a combination of low-dose warfarin and low-dose aspirin would give superior results to standard aspirin monotherapy without excessive bleeding risk. Methods We used a randomised double-blind study design. At 293 sites, we randomly assigned 8803 patients who had had myocardial infarction, treatment with 160 mg aspirin, 3 mg warfarin with 80 mg aspirin, or 1 mg warfarin with 80 mg aspirin. Patients took a single tablet daily, and attended for prothrombin time (PT) measurements at weeks 1, 2, 3, 4, 6, and12, and then every 3 months. Patients were followed up for a maximum of 33 months (median 14 months). Findings The primary event was first occurrence of reinfarction, non-fatal ischaemic stroke, or cardiovascular death. 1-year life-table estimates for the primary event were 8.6%(95% Cl 7.6-9.6) for 160 mg aspirin, 8.4% (7.4-9.4) for 3 mg warfarinwith 80 mg aspirin, and 8.8% (7.6-10) for 1 mg warfarin with 80 mg aspirin. Primary comparisons were done with all follow-up data. The relative risk of the primary event for the 160 mg aspirin group compared with the 3 mg warfarin with 80 mg aspirin group was 0.95 (0.81-1.12, p=0.57). For spontaneous major haemorrhage (not procedure related), 1-year life-table estimates were 0.74% (0.43-1.1) in the 160 mg aspirin group and 1.4% (0.94-1.8) in the 3 mg warfarin with 80 mg aspirin group (p=0.014 log rank on follow-up). For the 3382 patients assigned 3 mg warfarin with 80 mg aspirin, the INR results were: at week 1 (n=2985) median 1.51 (IQR 1.23-2.13); at week 4 (n=2701) 1.27 (1.13-1.64); at month 6 (n=2145) 1.19 (1.08-1.44). Interpretation Low, fixed-dose warfarin (1 mg or 3 mg) combined with low-dose aspirin (80 mg) in patients who have had myocardial infarction does not provide clinical benefit beyond that achievable with 160 mg aspirin monotherapy.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 24/11/20 alle ore 14:00:41