Abstract:
BACKGROUND:The efficacy and safety of warfarin for stroke prevention in atrial fibrillation (AF) depend on the time in the therapeutic range (TTR) with an international normalised ratio (INR) of 2.0-3.0. This meta-analysis focused the relative efficacy and safety of non-VKA oral anticoagulants (NOAC) compared with warfarin at different thresholds of centre's TTR (cTTR). METHODS:We searched PubMed, Embase, CENTRAL and websites of regulatory agencies, limiting searches to randomized phase 3 trials. Primary outcomes were stroke or systemic embolism (SSE) and major or non-major clinically relevant (NMCR) bleeding. We used a random-effects model to pool effect on outcomes according to different thresholds of cTTR. RESULTS:Four TTR sub-studies with a total of 71,222 patients were included. The benefit of NOAC in reducing SSE compared with warfarin was significantly higher in patients at cTTR<60% (HR 0.79, 95% CI 0.68-0.90) and at 60% to <70% (0.82, 0.71-0.95) but not at ≥70% (1.00, 0.82-1.23) with a significant interaction for cTTR<70% or ≥70% (p=0.042). The risk of major or NMCR bleeding was significantly lower with NOAC as compared with warfarin in patients at all sub-groups (0.67, 0.54-0.83 for patients at cTTR<60% and 0.75, 0.63-0.89 at 60% to <70%) except for cTTR≥70% (HR 0.84, 0.64-1.11), but the interaction for cTTR<70% or ≥70% was not statistically significant (p=0.271). CONCLUSIONS:The superiority in efficacy of NOAC compared with warfarin for stroke prevention is lost above a cTTR threshold of approximately 70%, but the relative safety appears to be less modified by the centre-based quality of INR control.
journal_name
Int J Cardioljournal_title
International journal of cardiologyauthors
Carmo J,Ferreira J,Costa F,Carmo P,Cavaco D,Carvalho S,Morgado F,Adragão P,Mendes Mdoi
10.1016/j.ijcard.2017.06.004subject
Has Abstractpub_date
2017-10-01 00:00:00pages
196-201eissn
0167-5273issn
1874-1754pii
S0167-5273(17)31600-5journal_volume
244pub_type
杂志文章,meta分析abstract::The negative inotropism, myocardial dilatation and cytotoxicity in inflammatory heart disorders may be due to increased generation of nitric oxide (NO) by immunological induction of a high output NO pathway. This short review discusses the initial experiments which lead to this hypothesis, and evaluates data that this...
journal_title:International journal of cardiology
pub_type: 杂志文章,评审
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abstract::Coronary artery bypass grafting without cardiopulmonary bypass (CPB) is now an accepted technique of myocardial revascularization in a special subset of patients. This paper presents our total experience in 1761 cases operated on since September 1981 until April 1997 out of a total of 9164 patients revascularized with...
journal_title:International journal of cardiology
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journal_title:International journal of cardiology
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abstract::The pharmacological management of atrial fibrillation (AF) requires careful consideration from a safety perspective. This article focuses primarily on maintenance therapy using antiarrhythmic drugs (AADs). The foremost safety issue for AADs is the propensity of class IA and III agents to cause torsade de pointes arrhy...
journal_title:International journal of cardiology
pub_type: 杂志文章,评审
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pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2013-09-10 00:00:00
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journal_title:International journal of cardiology
pub_type: 信件
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更新日期:2007-10-01 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章,随机对照试验
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更新日期:2012-03-22 00:00:00
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更新日期:2020-05-15 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章
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journal_title:International journal of cardiology
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pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:International journal of cardiology
pub_type: 杂志文章
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更新日期:2010-05-14 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章,评审
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journal_title:International journal of cardiology
pub_type: 杂志文章
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更新日期:2008-08-01 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章,评审
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journal_title:International journal of cardiology
pub_type: 杂志文章
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journal_title:International journal of cardiology
pub_type: 信件
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journal_title:International journal of cardiology
pub_type: 杂志文章
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journal_title:International journal of cardiology
pub_type: 杂志文章
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更新日期:1996-12-13 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章
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更新日期:2019-10-01 00:00:00