Dabigatran versus warfarin in patients with atrial fibrillation
Stuart J. Connolly,Michael D. Ezekowitz,John W. Eikelboom,Jonas Oldgren,Amit Parekh,Janice Pogue,Paul A. Reilly,Ellison Themeles,Jeanne Varrone,Susan Wang,Marco Alings,Denis Xavier,Jun Zhu,Rafael Diaz,Basil S. Lewis,Harald Darius,Hans-Christoph Diener,Campbell D. Joyner,Lars Wallentin +18 more
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TLDR
In patients with atrial fibrillation, dabigatran given at a dose of 110 mg was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin, as well as lower rates of major hemorrhage.Abstract:
Background Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use. Dabigatran is a new oral direct thrombin inhibitor. Methods In this noninferiority trial, we randomly assigned 18,113 patients who had atrial fibrillation and a risk of stroke to receive, in a blinded fashion, fixed doses of dabigatran — 110 mg or 150 mg twice daily — or, in an unblinded fashion, adjusted-dose warfarin. The median duration of the follow-up period was 2.0 years. The primary outcome was stroke or systemic embolism. Results Rates of the primary outcome were 1.69% per year in the warfarin group, as compared with 1.53% per year in the group that received 110 mg of dabigatran (relative risk with dabigatran, 0.91; 95% confidence interval [CI], 0.74 to 1.11; P<0.001 for noninferiority) and 1.11% per year in the group that received 150 mg of dabigatran (relative risk, 0.66; 95% CI, 0.53 to 0.82; P<0.001 for superiority). The rate of major bleeding was 3.36% per year in the warfarin group, as compared with 2.71% per year in the group receiving 110 mg of dabigatran (P = 0.003) and 3.11% per year in the group receiving 150 mg of dabigatran (P = 0.31). The rate of hemorrhagic stroke was 0.38% per year in the warfarin group, as compared with 0.12% per year with 110 mg of dabigatran (P<0.001) and 0.10% per year with 150 mg of dabigatran (P<0.001). The mortality rate was 4.13% per year in the warfarin group, as compared with 3.75% per year with 110 mg of dabigatran (P = 0.13) and 3.64% per year with 150 mg of dabigatran (P = 0.051). Conclusions In patients with atrial fibrillation, dabigatran given at a dose of 110 mg was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin, as well as lower rates of major hemorrhage. Dabigatran administered at a dose of 150 mg, as compared with warfarin, was associated with lower rates of stroke and systemic embolism but similar rates of major hemorrhage. (ClinicalTrials.gov number, NCT00262600.)read more
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
Piotr Ponikowski,Adriaan A. Voors,Stefan D. Anker,Héctor Bueno,John G.F. Cleland,Andrew J.S. Coats,Volkmar Falk,José Ramón González-Juanatey,Veli-Pekka Harjola,Ewa A. Jankowska,Mariell Jessup,Cecilia Linde,Petros Nihoyannopoulos,John Parissis,Burkert Pieske,Jillian P. Riley,Giuseppe M.C. Rosano,Luis M. Ruilope,Frank Ruschitzka,Frans H. Rutten,Peter van der Meer,Gerasimos Filippatos,John J.V. McMurray,Victor Aboyans,Stephan Achenbach,Stefan Agewall,Nawwar Al-Attar,John Atherton,Johann Bauersachs,A. John Camm,Scipione Carerj,Claudio Ceconi,Antonio Coca,Perry M. Elliott,Çetin Erol,Justin A. Ezekowitz,Covadonga Fernández-Golfín,Donna Fitzsimons,Marco Guazzi,Maxime Guenoun,Gerd Hasenfuss,Gerhard Hindricks,Arno W. Hoes,Bernard Iung,Tiny Jaarsma,Paulus Kirchhof,Juhani Knuuti,Philippe Kolh,Stavros Konstantinides,Mitja Lainscak,Patrizio Lancellotti,Gregory Y.H. Lip,Francesco Maisano,Christian Mueller,Mark C. Petrie,Massimo F Piepoli,Silvia G. Priori,Adam Torbicki,Hiroyuki Tsutsui,Dirk J. van Veldhuisen,Stephan Windecker,Clyde W. Yancy,José Luis Zamorano +62 more
TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
Journal ArticleDOI
2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Clyde W. Yancy,Mariell Jessup,Biykem Bozkurt,Javed Butler,Donald E. Casey,Mark H. Drazner,Gregg C. Fonarow,Stephen A. Geraci,Tamara B. Horwich,James L. Januzzi,Maryl R. Johnson,Edward K. Kasper,Wayne C. Levy,Frederick A. Masoudi,Patrick E. McBride,John J.V. McMurray,Judith E. Mitchell,Pamela N. Peterson,Barbara Riegel,Flora Sam,Lynne W. Stevenson,W.H. Wilson Tang,Emily J. Tsai,Bruce L. Wilkoff +23 more
TL;DR: In this article, Anderson et al. proposed a new FAHA Chair, Jeffrey L. Anderson, MD, FACC, FAHA, Chair-Elect, Alice K. Jacobs et al., this article and Biykem Bozkurt.
Journal ArticleDOI
Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation
Manesh R. Patel,Kenneth W. Mahaffey,Jyotsna Garg,Guohua Pan,Daniel E. Singer,Werner Hacke,Günter Breithardt,Jonathan L. Halperin,Graeme J. Hankey,Jonathan P. Piccini,Richard C. Becker,Christopher C. Nessel,John F. Paolini,Scott D. Berkowitz,Robert M. Califf +14 more
TL;DR: In patients with atrial fibrillation, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism and there was no significant between-group difference in the risk of major bleeding, although intracranial and fatal bleeding occurred less frequently in the rivroxaban group.
Journal ArticleDOI
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Piotr Ponikowski,Adriaan A. Voors,Stefan D. Anker,Héctor Bueno,John G.F. Cleland,Andrew J.S. Coats,Volkmar Falk,José Ramón González-Juanatey,Veli-Pekka Harjola,Ewa A. Jankowska,Mariell Jessup,Cecilia Linde,Petros Nihoyannopoulos,John Parissis,Burkert Pieske,Jillian P. Riley,Giuseppe M.C. Rosano,Luis M. Ruilope,Frank Ruschitzka,Frans H. Rutten,Peter van der Meer +20 more
TL;DR: ACCF/AHAIAI: angiotensin-converting enzyme inhibitor as discussed by the authors, angio-catabolizing enzyme inhibitor inhibitor inhibitor (ACS inhibitor) is a drug that is used to prevent atrial fibrillation.
Journal ArticleDOI
Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
TL;DR: These guidelines supersede the prior 2007 guidelines and 2009 updates and support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit.
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Stuart J. Connolly,J Pogue,Robert G. Hart,Marc A. Pfeffer,S H Hohnloser,Susan Chrolavicius,Salim Yusuf +6 more
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