Dabigatran versus Warfarin in Patients with Atrial Fibrillation.

被引：8520

作者：

Connolly, Stuart J. ^{[1
,2
]}

Ezekowitz, Michael D. ^{[3
,4
]}

Yusuf, Salim ^{[1
,2
]}

Eikelboom, John ^{[1
,2
]}

Oldgren, Jonas ^{[5
]}

Parekh, Amit ^{[3
,4
]}

Pogue, Janice ^{[1
,2
]}

Reilly, Paul A. ^{[6
]}

Themeles, Ellison ^{[1
,2
]}

Varrone, Jeanne ^{[6
]}

Wang, Susan ^{[6
]}

Alings, Marco ^{[7
]}

Xavier, Denis ^{[8
]}

Zhu, Jun ^{[9
]}

Diaz, Rafael ^{[10
]}

Lewis, Basil S. ^{[11
]}

Darius, Harald ^{[12
]}

Diener, Hans-Christoph ^{[13
]}

Joyner, Campbell D. ^{[14
]}

Wallentin, Lars ^{[5
]}

机构：

[1] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON L8L 2X2, Canada

[2] Hamilton Hlth Sci, Hamilton, ON, Canada

[3] Lankenau Inst Med Res, Wynnewood, PA USA

[4] Ctr Heart, Wynnewood, PA USA

[5] Uppsala Clin Res Ctr, Uppsala, Sweden

[6] Boehringer Ingelheim Pharmaceut Inc, Ridgefield, CT 06877 USA

[7] Working Grp Cardiovasc Res Netherlands, Utrecht, Netherlands

[8] St Johns Natl Acad Hlth Sci, Bangalore, Karnataka, India

[9] FuWai Hosp, Beijing, Peoples R China

[10] Estudios Clin Latinoamer, Rosario, Santa Fe, Argentina

[11] Lady Davies Carmel Med Ctr, Haifa, Israel

[12] Vivantes Klinikum Neukolln, Berlin, Germany

[13] Univ Duisburg Essen, Essen, Germany

[14] Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2009年 / 361卷 / 12期

关键词：

NON-INFERIORITY TRIAL; ANTITHROMBOTIC THERAPY; ANTICOAGULANT-THERAPY; ORAL ANTICOAGULANT; PREVENT STROKE; ASPIRIN; THROMBOEMBOLISM; METAANALYSIS; CLOPIDOGREL; ETEXILATE;

D O I：

10.1056/NEJMoa0905561

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.) N Engl J Med 2009;361:1139-51.

引用

页码：1139 / 1151

页数：13

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