| Randomized trial of warfarin, aspirin, and clopidogrel in patients with chronic heart failure: the Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial. | |
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MedLine Citation:
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PMID: 19289640 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Chronic heart failure remains a major cause of mortality and morbidity. The role of antithrombotic therapy in patients with chronic heart failure has long been debated. The objective of this study was to determine the optimal antithrombotic agent for heart failure patients with reduced ejection fractions who are in sinus rhythm. METHODS AND RESULTS: This prospective, randomized clinical trial of open-label warfarin (target international normalized ratio of 2.5 to 3.0) and double-blind treatment with either aspirin (162 mg once daily) or clopidogrel (75 mg once daily) had a 30-month enrollment period and a minimum of 12 months of treatment. We enrolled 1587 men and women >/=18 years of age with symptomatic heart failure for at least 3 months who were in sinus rhythm and had left ventricular ejection fraction of </=35%. The primary outcome was the time to first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke. For the primary composite end point, the hazard ratios were as follows: for warfarin versus aspirin, 0.98 (95% CI, 0.86 to 1.12; P=0.77); for clopidogrel versus aspirin, 1.08 (95% CI, 0.83 to 1.40; P=0.57); and for warfarin versus clopidogrel, 0.89 (95% CI, 0.68 to 1.16; P=0.39). Warfarin was associated with fewer nonfatal strokes than aspirin or clopidogrel. Hospitalization for worsening heart failure occurred in 116 (22.2%), 97 (18.5%), and 89 (16.5%) patients treated with aspirin, clopidogrel, and warfarin, respectively (P=0.02 for warfarin versus aspirin). CONCLUSIONS: The primary outcome measure and the mortality data do not support the primary hypotheses that warfarin is superior to aspirin and that clopidogrel is superior to aspirin. |
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Authors:
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Barry M Massie; Joseph F Collins; Susan E Ammon; Paul W Armstrong; John G F Cleland; Michael Ezekowitz; Syed M Jafri; William F Krol; Christopher M O'Connor; Kevin A Schulman; Koon Teo; Stuart R Warren; |
Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S. Date: 2009-03-16 |
Journal Detail:
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Title: Circulation Volume: 119 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2009 Mar |
Date Detail:
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Created Date: 2009-03-31 Completed Date: 2009-04-24 Revised Date: 2009-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 1616-24 Citation Subset: AIM; IM |
Affiliation:
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Department of Veterans Affairs, San Francisco, CA, USA. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00007683 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Aspirin / administration & dosage Chronic Disease Death Double-Blind Method Female Fibrinolytic Agents / administration & dosage* Heart Failure / complications, drug therapy*, mortality Humans Male Middle Aged Myocardial Infarction Stroke Stroke Volume Ticlopidine / administration & dosage, analogs & derivatives Warfarin / administration & dosage |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 81-81-2/Warfarin; 90055-48-4/clopidogrel |
| Comments/Corrections | |
Comment In:
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Circulation. 2009 Nov 17;120(20):e164
[PMID:
19917893
]
Circulation. 2009 Mar 31;119(12):1559-61 [PMID: 19332479 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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