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#1
13.12.2006, 22:07
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варфарин vs клопидогрель+аспирин (ACTIVE W)
Эх, такая идея потерпела фиаско..
 Источник: [Ссылки доступны только зарегистрированным пользователям ] Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. ACTIVE Writing Group on behalf of the ACTIVE Investigators; Connolly S, Pogue J, Hart R, Pfeffer M, Hohnloser S, Chrolavicius S, Pfeffer M, Hohnloser S, Yusuf S. BACKGROUND: Oral anticoagulation therapy reduces risk of vascular events in patients with atrial fibrillation. However, long-term monitoring is necessary and many patients cannot achieve optimum anticoagulation. We assessed whether clopidogrel plus aspirin was non-inferior to oral anticoagulation therapy for prevention of vascular events. METHODS: Patients were enrolled if they had atrial fibrillation plus one or more risk factor for stroke, and were randomly allocated to receive oral anticoagulation therapy (target international normalised ratio of 2.0-3.0; n=3371) or clopidogrel (75 mg per day) plus aspirin (75-100 mg per day recommended; n=3335). Outcome events were adjudicated by a blinded committee. Primary outcome was first occurrence of stroke, non-CNS systemic embolus, myocardial infarction, or vascular death. Analyses were by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00243178. RESULTS: The study was stopped early because of clear evidence of superiority of oral anticoagulation therapy. There were 165 primary events in patients on oral anticoagulation therapy (annual risk 3.93%) and 234 in those on clopidogrel plus aspirin (annual risk 5.60%; relative risk 1.44 (1.18-1.76; p=0.0003). Patients on oral anticoagulation therapy who were already receiving this treatment at study entry had a trend towards a greater reduction in vascular events (relative risk 1.50, 95% CI 1.19-1.89) and a significantly (p=0.03 for interaction) lower risk of major bleeding with oral anticoagulation therapy (1.30; 0.94-1.79) than patients not on this treatment at study entry (1.27, 0.85-1.89 and 0.59, 0.32-1.08, respectively). CONCLUSION: Oral anticoagulation therapy is superior to clopidogrel plus aspirin for prevention of vascular events in patients with atrial fibrillation at high risk of stroke, especially in those already taking oral anticoagulation therapy. 
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#5
14.12.2006, 23:45
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По идее (правда не при ФП, а после ИИ/ТИА) еще ожидаются результаты ESPRIT, где дипи+аспирин сравнивались не только с аспирином, но и с варфарином МНО 2.0-3.0:
ESPRIT is an open randomized clinical trial comparing (A) oral anticoagulation with a target INR between 2.0 and 3.0 or (B) the combination of aspirin (30 to 325 mg daily) and dipyridamole (400 mg daily) with (C) aspirin only (same dose). The trial seeks to recruit 4500 patients with a mean follow-up of 3 years. Primary outcome is the composite of vascular death, nonfatal stroke, nonfatal myocardial infarction, or major bleeding complication. Тогда как результаты дипи+аспирин против аспирина уже заафишировали в этом году, о варфариновой группе пока ни слова, может решили протянуть еще годик для получения из трендов значимой статистики?
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#6
16.12.2006, 00:52
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Цитата:
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#8
16.12.2006, 17:03
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Цитата:
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#9
16.12.2006, 22:04
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1. По дизайну RE-LY - это тот же SPORTIF, но с гораздо большим числом пациентов?
SPORTIF V Albers GW et al. "Ximelagatran vs warfarin for stroke prevention in patients with nonvalvular atrial fibrillation: a randomized trial". JAMA. 2005 Feb 9;293(6):690-8. "CONCLUSIONS: The results establish the efficacy of fixed-dose oral ximelagatran without coagulation monitoring compared with well-controlled warfarin for prevention of thromboembolism in patients with atrial fibrillation requiring chronic anticoagulant therapy, but the potential for hepatotoxicity requires further investigation." [Ссылки доступны только зарегистрированным пользователям ] 2. Прямые ингибиторы тромбина пока ещё экзотика в России, интересная обзорная статья. Мне было интересно. R Katira, A Chauhan and R S More "Direct thrombin inhibitors: novel antithrombotics on the horizon in the thromboprophylactic management of atrial fibrillation" Postgrad. Med. J. 2005;81;370-375 [Ссылки доступны только зарегистрированным пользователям ]
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#10
16.12.2006, 23:37
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Немного устаревшая инфа..., на мой взгляд нынешняя ситуация по новым антитромботикам в открытом доступе представлена у
New Anticoagulants Kenneth A. Bauer [Ссылки доступны только зарегистрированным пользователям ]
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Линейный вид
