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AFTER
Aspirin/Anticoagulants Following Thrombolysis with anistreplase (Eminase) in Recurrent infarction
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Author(s) |
Julian DG, Chamberlain DA, Pocock SJ
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Title(s) |
A comparison of aspirin and anticoagulation following thrombolysis for myocardial infarction (the AFTER study): a multicentre unblinded randomised clinical trial
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Reference(s) |
BMJ 1996;313:1429-31
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Disease |
AMI
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Purpose |
To compare the effect on cardiac death and reinfarction of aspirin with anticoagulant therapy
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Study design |
Randomised, open, controlled
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Follow-up |
30 days, 3 months
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Patients |
1036 patients (aim 1856). Time since onset of symptoms: ≤ 6 h
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Treatment regimen |
All patients anistreplase, 30 U, then randomised to either aspirin, 150 mg/day, or heparin, 1000 U/h iv for 24 h, beginning 6 h after anistreplase, plus oral anticoagulants to maintain an international normalised ratio in the range 2.0-2.5. Both regimens were continued for 3 months
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Results |
There were no significant differences in the incidence of cardiac events between the 2 groups. After 30 days, cardiac death or reinfarction occurred in 11% of the anticoagulation group and 11.2% of the aspirin group. At 3 months, the corresponding rates were 13.2% (anticoagulation) and 12.1% (aspirin). Severe bleeding or stroke by 3 months was more common in the anticoagulation group than in the aspirin group (3.9% vs 1.7%; p = 0.04)
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Comments |
The trial was stopped earlier than intended because of the slowing rate of recruitment
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