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Statements

Subject Item
n2:RIV%2F00023001%3A_____%2F12%3A00057976%21RIV13-MZ0-00023001
rdf:type
skos:Concept n10:Vysledek
rdfs:seeAlso
http://www.nejm.org/doi/pdf/10.1056/NEJMoa1202299
dcterms:description
We designed this trial to determine whether warfarin (with a target internationalnormalized ratio of 2.0 to 3.5) or aspirin (at a dose of 325 mg per day) is a better treatment for patients in sinus rhythm who have a reduced left ventricular ejection fraction (LVEF). We followed 2305 patients for up to 6 years (mean [+-SD], 3.5+-1.8). The primary outcome was the time to the first event in a composite end point of ischemic stroke, intracerebral hemorrhage, or death from any cause. RESULTS: The rates of the primary outcome were 7.47 events per 100 patient-years in the warfarin group and 7.93 in the aspirin group (hazard ratio with warfarin, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P = 0.40). Thus, there was no significant overall difference between the two treatments. In a time-varying analysis, the hazard ratio changed over time, slightly favoring warfarin over aspirin by the fourth year of follow-up, but this finding was only marginally significant (P = 0.046). Warfarin, as compared with aspirin, was associated with a significant reduction in the rate of ischemic stroke throughout the follow-up period (0.72 events per 100 patient-years vs. 1.36 per 100 patient-years; hazard ratio, 0.52; 95% CI, 0.33 to 0.82; P = 0.005). The rate of major hemorrhage was 1.78 events per 100 patient-years in the warfarin group as compared with 0.87 in the aspirin group (P<0.001). The rates of intracerebral and intracranial hemorrhage did not differ significantly between the two treatment groups (0.27 events per 100 patient-years with warfarin and 0.22 with aspirin, P = 0.82). Among patients with reduced LVEF who were in sinus rhythm, there was no significant overall difference in the primary outcome between treatment with warfarin and treatment with aspirin. A reduced risk of ischemic stroke with warfarin was offset by an increased risk of major hemorrhage. The choice between warfarin and aspirin should be individualized. We designed this trial to determine whether warfarin (with a target internationalnormalized ratio of 2.0 to 3.5) or aspirin (at a dose of 325 mg per day) is a better treatment for patients in sinus rhythm who have a reduced left ventricular ejection fraction (LVEF). We followed 2305 patients for up to 6 years (mean [+-SD], 3.5+-1.8). The primary outcome was the time to the first event in a composite end point of ischemic stroke, intracerebral hemorrhage, or death from any cause. RESULTS: The rates of the primary outcome were 7.47 events per 100 patient-years in the warfarin group and 7.93 in the aspirin group (hazard ratio with warfarin, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P = 0.40). Thus, there was no significant overall difference between the two treatments. In a time-varying analysis, the hazard ratio changed over time, slightly favoring warfarin over aspirin by the fourth year of follow-up, but this finding was only marginally significant (P = 0.046). Warfarin, as compared with aspirin, was associated with a significant reduction in the rate of ischemic stroke throughout the follow-up period (0.72 events per 100 patient-years vs. 1.36 per 100 patient-years; hazard ratio, 0.52; 95% CI, 0.33 to 0.82; P = 0.005). The rate of major hemorrhage was 1.78 events per 100 patient-years in the warfarin group as compared with 0.87 in the aspirin group (P<0.001). The rates of intracerebral and intracranial hemorrhage did not differ significantly between the two treatment groups (0.27 events per 100 patient-years with warfarin and 0.22 with aspirin, P = 0.82). Among patients with reduced LVEF who were in sinus rhythm, there was no significant overall difference in the primary outcome between treatment with warfarin and treatment with aspirin. A reduced risk of ischemic stroke with warfarin was offset by an increased risk of major hemorrhage. The choice between warfarin and aspirin should be individualized.
dcterms:title
Warfarin and aspirin in patients with heart failure and sinus rhythm Warfarin and aspirin in patients with heart failure and sinus rhythm
skos:prefLabel
Warfarin and aspirin in patients with heart failure and sinus rhythm Warfarin and aspirin in patients with heart failure and sinus rhythm
skos:notation
RIV/00023001:_____/12:00057976!RIV13-MZ0-00023001
n10:predkladatel
n11:ico%3A00023001
n3:aktivita
n13:N
n3:aktivity
N
n3:cisloPeriodika
20
n3:dodaniDat
n4:2013
n3:domaciTvurceVysledku
n14:9540628 n14:8114021
n3:druhVysledku
n15:J
n3:duvernostUdaju
n18:S
n3:entitaPredkladatele
n19:predkladatel
n3:idSjednocenehoVysledku
180706
n3:idVysledku
RIV/00023001:_____/12:00057976
n3:jazykVysledku
n12:eng
n3:klicovaSlova
cardiology
n3:klicoveSlovo
n9:cardiology
n3:kodStatuVydavatele
US - Spojené státy americké
n3:kontrolniKodProRIV
[B0574C250653]
n3:nazevZdroje
New England journal of medicine
n3:obor
n8:FA
n3:pocetDomacichTvurcuVysledku
2
n3:pocetTvurcuVysledku
26
n3:rokUplatneniVysledku
n4:2012
n3:svazekPeriodika
366
n3:tvurceVysledku
Graham, S. Málek, Ivan Thompson, JLP Mejia, V. Sacco, RL Pullicino, P. M. Labovitz, AJ Mann, DL Estol, CJ Anker, S. D. Ponikowski, P. Sanford, AR Lok, DJ Ammon, SE Gabriel, AP del Valle, M. L. Teerlink, JR Levin, B. Buchsbaum, R. Massie, BM Homma, S. Di Tullio,, M. R. Křížová, Barbora Freudenberger, RS Lip, GYH Mohr, J. P.
n3:wos
000304083000005
s:issn
0028-4793
s:numberOfPages
11
n6:doi
10.1056/NEJMoa1202299