12559a8624300c8d8110f94b7a9d6432.ppt
- Количество слайдов: 6
VBWG High incidence of asymptomatic AF 110 patients with history of paroxysmal/persistent AF but in sinus rhythm at baseline. All patients received antiarrhythmic drug therapy AF detected by implanted monitoring pacemaker 100 80 P < 0. 0001 60 Patients 40 AF detected by ECG at follow-up (FU) visit 20 0 Baseline FU 1 FU 2 FU 3 FU 4 FU 5 FU 6 FU 7 FU 8 n 110 110 85 73 60 48 39 110 FU 9 FU 10 25 15 Israel CW et al. J Am Coll Cardiol. 2004: 43: 47 -52.
High incidence of asymptomatic AF: Clinical implications VBWG “The implications for treatment are clear, namely that apparent freedom from AF does not, per se, obviate the need for oral anticoagulation. ” Kaufman ES, Waldo AL. J Am Coll Cardiol. 2004; 43: 53 -4.
VBWG Warfarin increases hemorrhagic stroke mortality INR Odds ratio* (3 -mos mortality) <2. 0– 3. 0 >3. 0 1. 9 2. 7 5. 5 Lobar ICH 60 % Patients 57. 6 40 20 Deep hemispheric ICH 60 40 28. 6 20 0 44. 2 22. 5 0 No warfarin Warfarin ICH = intracerebral hemorrhage *Relative to no warfarin; P < 0. 01 for trend across INR categories No warfarin Warfarin Rosand J et al. Arch Intern Med. 2004; 164: 880 -4.
VBWG Trials of emerging antithrombotic therapies for stroke prevention in AF Trial Treatment Status AMADEUS Idraparinux* vs warfarin Ongoing ACTIVE Clopidogrel + aspirin vs warfarin (ACTIVE W) or vs aspirin (ACTIVE A) Ongoing SPORTIF III/V Ximelagatran vs warfarin Completed *Administered sc 1 /week Hankey GJ et al. Stroke. 2004; 35: 389 -91.
VBWG SPORTIF III and V pooled results: Primary outcome Ximelagatran better Warfarin better – 0. 66 P = 0. 10 SPORTIF III +0. 45 P = 0. 13 SPORTIF V – 0. 03 Pooled P = 0. 94 Noninferiority -4 -3 Stroke Prevention using an ORal Thrombin Inhibitor in patients with atrial Fibrillation -2 -1 0 1 2 Difference in absolute event rates (ximelagatran – warfarin) 3 4 Halperin JL. AHA Scientific Sessions 2003; Orlando, Fla.
VBWG SPORTIF III and V pooled results: Net clinical benefit On-treatment analysis Warfarin Ximelagatran Primary events + major bleeding + death 10 8 Event 6 rate (%/year) 4 RRR = 26% P = 0. 019 6. 1 RRR = 7% P = 0. 527 6. 3 5. 8 4. 6 RRR = 16% P = 0. 038 6. 2 5. 2 2 0 SPORTIF III SPORTIF V Pooled RRR = relative risk reduction Stroke Prevention using an ORal Thrombin Inhibitor in patients with atrial Fibrillation Halperin JL. AHA Scientific Sessions 2003; Orlando, Fla.
12559a8624300c8d8110f94b7a9d6432.ppt