Abstract | BACKGROUND: METHODS: The ESTEEM trial evaluated 6 months treatment with ximelagatran together with aspirin, compared to aspirin alone, for prevention of ischemic events in 1883 patients randomized within 14 days after an MI. After their qualifying MI, 174 (9%) patients developed AF in hospital. Multivariate hazard ratios for ximelagatran compared with placebo were calculated by presence AF. RESULTS: Of 101 patients with AF treated with ximelagatran 7 (6.9%) had either death, MI, or stroke, compared with 15 (20.6%) in 73 patients allocated to placebo. Ximelagatran reduced the risk of death, MI, or stroke by 70% (hazard ratio 0.30, 95% CI 0.12-0.74). For the separate outcome events, we found similar, nonsignificant trends. One major bleeding event occurred in each treatment group. CONCLUSIONS: For patients with MI complicated by AF, the combination of aspirin and an oral direct thrombin inhibitor seems beneficial. The high risk for death, MI, and stroke in this population and the increasing use of percutaneous interventions in MI patients may suggest a combination of long-term antiplatelet and anticoagulant therapy. Randomized clinical trials are warranted.
|
Authors | Marco J D Tangelder, Lars Frison, Douglas Weaver, Robbert G Wilcox, Anders Bylock, Håkan Emanuelsson, Peter Held, Jonas Oldgren |
Journal | American heart journal
(Am Heart J)
Vol. 155
Issue 2
Pg. 382-7
(Feb 2008)
ISSN: 1097-6744 [Electronic] United States |
PMID | 18215612
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
|
Chemical References |
- Anticoagulants
- Azetidines
- Benzylamines
- Fibrinolytic Agents
- ximelagatran
- Aspirin
|
Topics |
- Administration, Oral
- Aged
- Anticoagulants
(administration & dosage)
- Aspirin
(therapeutic use)
- Atrial Fibrillation
(drug therapy, etiology, mortality)
- Azetidines
(administration & dosage)
- Benzylamines
(administration & dosage)
- Drug Therapy, Combination
- Female
- Fibrinolytic Agents
(therapeutic use)
- Humans
- Male
- Middle Aged
- Myocardial Infarction
(complications, mortality)
- Myocardial Ischemia
(prevention & control)
- Treatment Outcome
|