Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators.
Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators.
复制标题
华法林预防与非风湿性心房颤动相关的中风。
DOI：
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复制
发表时间：
1992
影响因子：
158.5
通讯作者：
D. Deykin
中科院分区：
文献类型：
--
作者：
M. Ezekowitz;S. Bridgers;K. James;N. Carliner;C. Colling;C. Gornick;H. Krause;J. Kurtzke;S. Nazarian;M. Radford;F. Rickles;R. Shabetai;D. Deykin
背景
非风湿性心房颤动在老年人中很常见，并且与中风风险增加有关。我们研究了华法林抗凝是否会降低这种风险。
方法
我们进行了一项随机、双盲、安慰剂对照研究，以评估 571 名患有慢性非风湿性心房颤动的男性患者使用华法林进行低强度抗凝治疗（凝血酶原时间比为 1.2 至 1.5）； 525 名患者此前未患过脑梗塞，而 46 名患者此前曾患过脑梗塞。主要终点是脑梗塞；次要终点是脑出血和死亡。
结果
在无中风病史的患者中，安慰剂组的 265 名患者中，平均随访 1.7 年期间，有 19 名患者发生脑梗塞（每年 4.3%）；华法林组的 260 名患者中，平均随访 1.8 年，有 4 名患者发生脑梗塞（每年 0.9%）。华法林治疗的风险降低为 0.79（95% 置信区间，0.52 至 0.90；P = 0.001）。 228 名 70 岁以上患者中，安慰剂组的年事件发生率为 4.8%，华法林组为 0.9%（风险降低，0.79；P = 0.02）。唯一的脑出血发生在华法林组的一名73岁患者身上。 10 名患者发生了其他严重出血（均为胃肠道出血）：安慰剂组有 4 名患者，年发生率为 0.9%；华法林组有 6 名，年发生率为 1.3%。有 37 例死亡之前没有脑终点事件——安慰剂组有 22 例死亡，华法林组有 15 例死亡（风险降低，0.31；P = 0.19）。有脑梗塞病史的患者（安慰剂组每年 9.3%，华法林组每年 6.1%）脑梗塞比无脑梗塞病史的患者更常见。
结论
华法林低强度抗凝治疗可预防非风湿性心房颤动患者发生脑梗死，且不会增加大出血的风险。这一益处延伸至 70 岁以上的患者。
BACKGROUND
Nonrheumatic atrial fibrillation is common among the elderly and is associated with an increased risk of stroke. We investigated whether anticoagulation with warfarin would reduce this risk.
METHODS
We conducted a randomized, double-blind, placebo-controlled study to evaluate low-intensity anticoagulation with warfarin (prothrombin-time ratio, 1.2 to 1.5) in 571 men with chronic nonrheumatic atrial fibrillation; 525 patients had not previously had a cerebral infarction, whereas 46 patients had previously had such an event. The primary end point was cerebral infarction; secondary end points were cerebral hemorrhage and death.
RESULTS
Among the patients with no history of stroke, cerebral infarction occurred in 19 of the 265 patients in the placebo group during an average follow-up of 1.7 years (4.3 percent per year) and in 4 of the 260 patients in the warfarin group during an average follow-up of 1.8 years (0.9 percent per year). The reduction in risk with warfarin therapy was 0.79 (95 percent confidence interval, 0.52 to 0.90; P = 0.001). The annual event rate among the 228 patients over 70 years of age was 4.8 percent in the placebo group and 0.9 percent in the warfarin group (risk reduction, 0.79; P = 0.02). The only cerebral hemorrhage occurred in a 73-year-old patient in the warfarin group. Other major hemorrhages, all gastrointestinal, occurred in 10 patients: 4 in the placebo group, for a rate of 0.9 percent per year, and 6 in the warfarin group, for a rate of 1.3 percent per year. There were 37 deaths that were not preceded by a cerebral end point--22 in the placebo group and 15 in the warfarin group (risk reduction, 0.31; P = 0.19). Cerebral infarction was more common among patients with a history of cerebral infarction (9.3 percent per year in the placebo group and 6.1 percent per year in the warfarin group) than among those without such a history.
CONCLUSIONS
Low-intensity anticoagulation with warfarin prevented cerebral infarction in patients with nonrheumatic atrial fibrillation without producing an excess risk of major hemorrhage. This benefit extended to patients over 70 years of age.
DOI：
10.1056/nejm199011293232201
发表时间：
1990-11
期刊：
The New England journal of medicine
影响因子：
--
作者：
D. Singer;R. Hughes;D. Gress;Mary A. Sheehan;L. Oertel;S. W. Maraventano;D. Blewett;B. Rosner;J. Kistler
通讯作者：
D. Singer;R. Hughes;D. Gress;Mary A. Sheehan;L. Oertel;S. W. Maraventano;D. Blewett;B. Rosner;J. Kistler
DOI：
10.1056/nejm199003223221232
发表时间：
1990
期刊：
The New England journal of medicine
影响因子：
--
作者：
StrokePreventioninAtrialFibrillationStudyGroupInvestigators
通讯作者：
StrokePreventioninAtrialFibrillationStudyGroupInvestigators