Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism.

@article{citeulike:2986504, abstract = {BACKGROUND: Standard therapy to prevent recurrent venous thromboembolism includes 3 to 12 months of treatment with full-dose warfarin with a target international normalized ratio (INR) between 2.0 and 3.0. However, for long-term management, no therapeutic agent has shown an acceptable benefit-to-risk ratio. METHODS: Patients with idiopathic venous thromboembolism who had received full-dose anticoagulation therapy for a median of 6.5 months were randomly assigned to placebo or low-intensity warfarin (target INR, 1.5 to 2.0). Participants were followed for recurrent venous thromboembolism, major hemorrhage, and death. RESULTS: The trial was terminated early after 508 patients had undergone randomization and had been followed for up to 4.3 years (mean, 2.1). Of 253 patients assigned to placebo, 37 had recurrent venous thromboembolism (7.2 per 100 person-years), as compared with 14 of 255 patients assigned to low-intensity warfarin (2.6 per 100 person-years), a risk reduction of 64 percent (hazard ratio, 0.36 [95 percent confidence interval, 0.19 to 0.67]; P<0.001). Risk reductions were similar for all subgroups, including those with and those without inherited thrombophilia. Major hemorrhage occurred in two patients assigned to placebo and five assigned to low-intensity warfarin (P=0.25). Eight patients in the placebo group and four in the group assigned to low-intensity warfarin died (P=0.26). Low-intensity warfarin was thus associated with a 48 percent reduction in the composite end point of recurrent venous thromboembolism, major hemorrhage, or death. According to per-protocol and as-treated analyses, the reduction in the risk of recurrent venous thromboembolism was between 76 and 81 percent. CONCLUSIONS: Long-term, low-intensity warfarin therapy is a highly effective method of preventing recurrent venous thromboembolism.}, address = {Center for Cardiovascular Disease Prevention and the Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston 02215, USA. pridker@partners.org}, author = {Ridker, P. M. and Goldhaber, S. Z. and Danielson, E. and Rosenberg, Y. and Eby, C. S. and Deitcher, S. R. and Cushman, M. and Moll, S. and Kessler, C. M. and Elliott, C. G. and Paulson, R. and Wong, T. and Bauer, K. A. and Schwartz, B. A. and Miletich, J. P. and Bounameaux, H. and Glynn, R. J. and }, citeulike-article-id = {2986504}, doi = {http://dx.doi.org/10.1056/NEJMoa035029}, issn = {1533-4406}, journal = {The New England journal of medicine}, keywords = {pe}, month = {April}, number = {15}, pages = {1425--1434}, posted-at = {2008-07-11 02:47:20}, priority = {2}, title = {Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism.}, url = {http://dx.doi.org/10.1056/NEJMoa035029}, volume = {348}, year = {2003} }

TY - JOUR ID - citeulike:2986504 L3 - citeulike-article-id:2986504 TI - Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. JF - The New England journal of medicine VL - 348 IS - 15 SP - 1425 EP - 1434 AD - Center for Cardiovascular Disease Prevention and the Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston 02215, USA. pridker@partners.org SN - 1533-4406 N2 - BACKGROUND: Standard therapy to prevent recurrent venous thromboembolism includes 3 to 12 months of treatment with full-dose warfarin with a target international normalized ratio (INR) between 2.0 and 3.0. However, for long-term management, no therapeutic agent has shown an acceptable benefit-to-risk ratio. METHODS: Patients with idiopathic venous thromboembolism who had received full-dose anticoagulation therapy for a median of 6.5 months were randomly assigned to placebo or low-intensity warfarin (target INR, 1.5 to 2.0). Participants were followed for recurrent venous thromboembolism, major hemorrhage, and death. RESULTS: The trial was terminated early after 508 patients had undergone randomization and had been followed for up to 4.3 years (mean, 2.1). Of 253 patients assigned to placebo, 37 had recurrent venous thromboembolism (7.2 per 100 person-years), as compared with 14 of 255 patients assigned to low-intensity warfarin (2.6 per 100 person-years), a risk reduction of 64 percent (hazard ratio, 0.36 [95 percent confidence interval, 0.19 to 0.67]; P<0.001). Risk reductions were similar for all subgroups, including those with and those without inherited thrombophilia. Major hemorrhage occurred in two patients assigned to placebo and five assigned to low-intensity warfarin (P=0.25). Eight patients in the placebo group and four in the group assigned to low-intensity warfarin died (P=0.26). Low-intensity warfarin was thus associated with a 48 percent reduction in the composite end point of recurrent venous thromboembolism, major hemorrhage, or death. According to per-protocol and as-treated analyses, the reduction in the risk of recurrent venous thromboembolism was between 76 and 81 percent. CONCLUSIONS: Long-term, low-intensity warfarin therapy is a highly effective method of preventing recurrent venous thromboembolism. KW - pe AU - Ridker, PM AU - Goldhaber, SZ AU - Danielson, E AU - Rosenberg, Y AU - Eby, CS AU - Deitcher, SR AU - Cushman, M AU - Moll, S AU - Kessler, CM AU - Elliott, CG AU - Paulson, R AU - Wong, T AU - Bauer, KA AU - Schwartz, BA AU - Miletich, JP AU - Bounameaux, H AU - Glynn, RJ PY - 2003/04/10/ UR - http://dx.doi.org/10.1056/NEJMoa035029 ER -