Direct thrombin inhibition and stroke prevention in elderly patients with atrial fibrillation - Experience from the SPORTIF III and V trials

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Direct thrombin inhibition and stroke prevention in elderly patients with atrial fibrillation - Experience from the SPORTIF III and V trials

Ford, Gary A. (författare)

Choy, Anna Maria (författare)

Deedwania, Prakash (författare)

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Karalis, Dean G. (författare)

Lindholm, Carl-Johan (författare): Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine

Pluta, Wladyslaw (författare)

Frison, Lars (författare)

Olsson, Bertil (författare): Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine

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(creator_code:org_t)

2007
2007
Engelska.
Ingår i: Stroke: a journal of cerebral circulation. - 1524-4628. ; 38:11, s. 2965-2971

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Tidskriftsartikel (refereegranskat)

Abstract Ämnesord

Stäng

Background and Purpose - Warfarin prevents stroke in atrial fibrillation (AF); however, concerns regarding international normalized ratio control and hemorrhage limit its use in the elderly. The oral direct thrombin inhibitors (DTIs) are potential alternatives to warfarin, offering fixed dosing without drug and dietary interactions and the need for international normalized ratio monitoring. Although ximelagatran, a DTI studied in the Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation trials, has been withdrawn, development of other DTIs continues. We report our experience in elderly high-risk AF patients on ximelagatran compared with warfarin therapy. Methods - Data from patients with AF and stroke risk factors randomized in Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation III and V trials to ximelagatran or warfarin were analyzed for stroke/systemic emboli, bleeding, and raised alanine aminotransferase levels in those >= 75 (n = 2804) and <75 (n = 4525) years. Results - Ximelagatran was as effective as warfarin in reducing stroke/systemic emboli in the elderly (2.23%/y with ximelagatran vs 2.27%/y with warfarin) as in younger patients (1.25%/y vs 1.28%/y). Total bleeds were significantly lower with ximelagatran compared with warfarin in elderly (40% vs 45%, P = 0.01) and younger (27% vs 35%, P < 0.001) patients. Raised alanine aminotransferase values (>3-fold elevation) among ximelagatran patients were more common in older (7.5% old vs 5.3% young) patients, particularly women (9.5% elderly women vs 6.1% elderly men). Conclusions - In high-risk elderly AF patients, ximelagatran is as effective as warfarin with less bleeding, but alanine aminotransferase elevations are common, particularly in elderly women. Oral DTIs for stroke prevention show promise in elderly patients.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

elderly
atrial fibrillation
stroke
direct thrombin inhibitors
ximelagatran

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Av författaren/redakt...: Ford, Gary A.; Choy, Anna Maria; Deedwania, Praka ...; Karalis, Dean G.; Lindholm, Carl-J ...; Pluta, Wladyslaw; visa fler...; Frison, Lars; Olsson, Bertil; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

Artiklar i publikationen: Stroke: a journa ...

Av lärosätet: Lunds universitet

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