17 research outputs found
Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease
BACKGROUND
We evaluated whether rivaroxaban alone or in combination with aspirin would be more
effective than aspirin alone for secondary cardiovascular prevention.
METHODS
In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg
once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after
a mean follow-up of 23 months.
RESULTS
The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group
than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard
ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major
bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288
patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05;
P<0.001). There was no significant difference in intracranial or fatal bleeding between
these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group
as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI,
0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome
did not occur in significantly fewer patients in the rivaroxaban-alone group than in the
aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group.
CONCLUSIONS
Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more
major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice
daily) alone did not result in better cardiovascular outcomes than aspirin alone and
resulted in more major bleeding events. (Funded by Bayer; COMPASS ClinicalTrials.gov
number, NCT01776424.
Verbeteren van het voorschrijven van antibiotica bij acute luchtweginfecties : ervaringen van huisartsen met twee contrasterende interventies
MODELING METALS TRANSPORT AND SEDIMENT/WATER INTERACTIONS IN A MINING IMPACTED MOUNTAIN STREAM
Bradycardia-Tachycardia Syndrome Due to Sinus Node Disease and Concealed Wolff-Parkinson-White Syndrome
The Induction of Atrial Flutter and Fibrillation and the Termination of Atrial Flutter by Esophageal Pacing
Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: A multinational, cluster, randomised, factorial, controlled trial
Background: High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. Methods After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. Results The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory- tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42-0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54-0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36-0·74, p<0·0001; enhanced communication 0·68, 0·50-0·89, p=0·003; combined 0·38, 0·25-0·55, p<0·0001). Interpretation Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries