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  1. AU="Lewis, Gayle"
  2. AU=Jain Harshwardhan AU=Jain Harshwardhan
  3. AU="Gaur, Aman"
  4. AU=Huynh Thu P.
  5. AU=Giebel Clarissa
  6. AU=Laskin Daniel M

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  1. Artikel ; Online: The Anti-Coronavirus Therapies (ACT) Trials: Design, Baseline Characteristics, and Challenges.

    Eikelboom, John / Rangarajan, Sumathy / Jolly, Sanjit S / Belley-Cote, Emilie P / Whitlock, Richard / Beresh, Heather / Lewis, Gayle / Xu, Lizhen / Chan, Noel / Bangdiwala, Shrikant / Diaz, Rafael / Orlandini, Andres / Hassany, Mohamed / Tarhuni, Wadea M / Yusufali, A M / Sharma, Sanjib Kumar / Kontsevaya, Anna / Lopez-Jaramillo, Patricio / Avezum, Alvaro /
    Dans, Antonio L / Wasserman, Sean / Felix, Camilo / Kazmi, Khawar / Pais, Prem / Xavier, Denis / Lopes, Renato D / Berwanger, Otavio / Nkeshimana, Menelas / Harper, William / Loeb, Mark / Choudhri, Shurjeel / Farkouh, Michael E / Bosch, Jackie / Anand, Sonia S / Yusuf, Salim

    CJC open

    2022  Band 4, Heft 6, Seite(n) 568–576

    Abstract: Background: Effective treatments for COVID-19 are urgently needed, but conducting randomized trials during the pandemic has been challenging.: Methods: The Anti-Coronavirus Therapy (ACT) trials are parallel factorial international trials that aimed ... ...

    Abstract Background: Effective treatments for COVID-19 are urgently needed, but conducting randomized trials during the pandemic has been challenging.
    Methods: The Anti-Coronavirus Therapy (ACT) trials are parallel factorial international trials that aimed to enroll 3500 outpatients and 2500 inpatients with symptomatic COVID-19. The outpatient trial is evaluating colchicine vs usual care, and aspirin vs usual care. The primary outcome for the colchicine randomization is hospitalization or death, and for the aspirin randomization, it is major thrombosis, hospitalization, or death. The inpatient trial is evaluating colchicine vs usual care, and the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily vs usual care. The primary outcome for the colchicine randomization is need for high-flow oxygen, need for mechanical ventilation, or death, and for the rivaroxaban plus aspirin randomization, it is major thrombotic events, need for high-flow oxygen, need for mechanical ventilation, or death.
    Results: At the completion of enrollment on February 10, 2022, the outpatient trial had enrolled 3917 patients, and the inpatient trial had enrolled 2611 patients. Challenges encountered included lack of preliminary data about the interventions under evaluation, uncertainties related to the expected event rates, delays in regulatory and ethics approvals, and in obtaining study interventions, as well as the changing pattern of the COVID-19 pandemic.
    Conclusions: The ACT trials will determine the efficacy of anti-inflammatory therapy with colchicine, and antithrombotic therapy with aspirin given alone or in combination with rivaroxaban, across the spectrum of mild, moderate, and severe COVID-19. Lessons learned from the conduct of these trials will inform planning of future trials.
    Sprache Englisch
    Erscheinungsdatum 2022-03-01
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ISSN 2589-790X
    ISSN (online) 2589-790X
    DOI 10.1016/j.cjco.2022.02.010
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  2. Artikel ; Online: Effect of apixaban on brain infarction and microbleeds: AVERROES-MRI assessment study.

    O'Donnell, Martin J / Eikelboom, John W / Yusuf, Salim / Diener, Hans-Christoph / Hart, Robert G / Smith, Eric E / Gladstone, David J / Sharma, Mukul / Dias, Rafael / Flaker, Greg / Avezum, Alvaro / Zhu, Jun / Lewis, Gayle / Connolly, Stuart

    American heart journal

    2016  Band 178, Seite(n) 145–150

    Abstract: Background: Clinical and subclinical (covert) stroke is a cause of cognitive loss and functional impairment. In the AVERROES trial, we performed serial brain magnetic resonance imaging (MRI) scans in a subgroup to explore the effect of apixaban, ... ...

    Abstract Background: Clinical and subclinical (covert) stroke is a cause of cognitive loss and functional impairment. In the AVERROES trial, we performed serial brain magnetic resonance imaging (MRI) scans in a subgroup to explore the effect of apixaban, compared with aspirin, on clinical and covert brain infarction and on microbleeds in patients with atrial fibrillation.
    Methods: We performed brain MRI (T1, T2, fluid-attenuated inversion recovery, and T2* gradient echo sequences) in 1,180 at baseline and in 931 participants at follow-up. Mean interval from baseline to follow-up MRI scans was 1.0 year. The primary outcome was a composite of clinical ischemic stroke and covert embolic pattern infarction (defined as infarction >1.5 cm, cortical-based infarction, or new multiterritory infarction). Secondary outcomes included new MRI-detected brain infarcts and microbleeds and change in white matter hyperintensities.
    Results: Baseline MRI scans revealed brain infarct(s) in 26.2% and microbleed(s) in 10.5%. The rate of the primary outcomes was 2.0% in the apixaban group and 3.3% in the aspirin group (hazard ratio [HR] 0.55; 0.27-1.14) from baseline to follow-up MRI scan (mean duration of follow-up: 1 year). In those who completed baseline and follow-up MRI scans, the rate of new infarction detected on MRI was 2.5% in the apixaban group and 2.2% in the aspirin group (HR 1.09; 0.47-2.52), but new infarcts were smaller in the apixaban group (P = .03). There was no difference in proportion with new microbleeds on follow-up MRI (HR 0.92; 0.53-1.60) between treatment groups.
    Conclusions: Apixaban treatment was associated with a nonsignificant trend toward reduction in the composite of clinical ischemic stroke and covert embolic-pattern infarction and did not increase the number of microbleeds in patients with atrial fibrillation compared with aspirin.
    Mesh-Begriff(e) Aged ; Aspirin/therapeutic use ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy ; Brain/diagnostic imaging ; Brain Infarction/diagnostic imaging ; Brain Infarction/etiology ; Brain Infarction/prevention & control ; Cerebral Hemorrhage/chemically induced ; Cerebral Hemorrhage/diagnostic imaging ; Embolism/etiology ; Embolism/prevention & control ; Factor Xa Inhibitors/therapeutic use ; Female ; Humans ; Longitudinal Studies ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/therapeutic use ; Proportional Hazards Models ; Pyrazoles/therapeutic use ; Pyridones/therapeutic use
    Chemische Substanzen Factor Xa Inhibitors ; Platelet Aggregation Inhibitors ; Pyrazoles ; Pyridones ; apixaban (3Z9Y7UWC1J) ; Aspirin (R16CO5Y76E)
    Sprache Englisch
    Erscheinungsdatum 2016-08
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Multicenter Study ; Randomized Controlled Trial
    ZDB-ID 80026-0
    ISSN 1097-6744 ; 0002-8703
    ISSN (online) 1097-6744
    ISSN 0002-8703
    DOI 10.1016/j.ahj.2016.03.019
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  3. Artikel ; Online: The INVICTUS rheumatic heart disease research program: Rationale, design and baseline characteristics of a randomized trial of rivaroxaban compared to vitamin K antagonists in rheumatic valvular disease and atrial fibrillation.

    Karthikeyan, Ganesan / Connolly, Stuart J / Ntsekhe, Mpiko / Benz, Alexander / Rangarajan, Sumathy / Lewis, Gayle / Yun, Yan / Sharma, Sanjib Kumar / Maklady, Fathi / Elghamrawy, Alaa Eldin / Kazmi, Khawar / Cabral, Tantchou T J / Dayi, Hu / Changsheng, Ma / Gitura, Bernard M / Avezum, Alvaro / Zuhlke, Liesl / Lwabi, Peter / Haileamlak, Abraham /
    Ogah, Okechukwu / Chillo, Pilly / Paniagua, Maria / ElSayed, Ahmed / Dans, Antonio / Gondwe-Chunda, Lillian / Molefe-Baikai, Onkabetse Julia / Gonzalez-Hermosillo, Jesus A / Hakim, James / Damasceno, Albertino / Kamanzi, Emmanuel R / Musuku, John / Davletov, Kairat / Connolly, Katherine / Mayosi, Bongani M / Yusuf, Salim

    American heart journal

    2020  Band 225, Seite(n) 69–77

    Abstract: Background: Rheumatic heart disease (RHD) is a neglected disease affecting 33 million people, mainly in low and middle income countries. Yet very few large trials or registries have been conducted in this population. The INVICTUS program of research in ... ...

    Abstract Background: Rheumatic heart disease (RHD) is a neglected disease affecting 33 million people, mainly in low and middle income countries. Yet very few large trials or registries have been conducted in this population. The INVICTUS program of research in RHD consists of a randomized-controlled trial (RCT) of 4500 patients comparing rivaroxaban with vitamin K antagonists (VKA) in patients with RHD and atrial fibrillation (AF), a registry of 17,000 patients to document the contemporary clinical course of patients with RHD, including a focused sub-study on pregnant women with RHD within the registry. This paper describes the rationale, design, organization and baseline characteristics of the RCT and a summary of the design of the registry and its sub-study. Patients with RHD and AF are considered to be at high risk of embolic strokes, and oral anticoagulation with VKAs is recommended for stroke prevention. But the quality of anticoagulation with VKA is poor in developing countries. A drug which does not require monitoring, and which is safe and effective for preventing stroke in patients with valvular AF, would fulfill a major unmet need.
    Methods: The INVestIgation of rheumatiC AF Treatment Using VKAs, rivaroxaban or aspirin Studies (INVICTUS-VKA) trial is an international, multicentre, randomized, open-label, parallel group trial, testing whether rivaroxaban 20 mg given once daily is non-inferior (or superior) to VKA in patients with RHD, AF, and an elevated risk of stroke (mitral stenosis with valve area ≤2 cm
    Conclusion: INVICTUS is the largest program of clinical research focused on a neglected cardiovascular disease and will provide new information on the clinical course of patients with RHD, and approaches to anticoagulation in those with concomitant AF.
    Mesh-Begriff(e) Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pregnancy ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy ; Embolism/prevention & control ; Factor Xa Inhibitors/adverse effects ; Factor Xa Inhibitors/therapeutic use ; Hemorrhage/chemically induced ; Pregnancy Complications, Cardiovascular/drug therapy ; Rheumatic Heart Disease/complications ; Rheumatic Heart Disease/drug therapy ; Rivaroxaban/adverse effects ; Rivaroxaban/therapeutic use ; Stroke/prevention & control ; Vitamin K/antagonists & inhibitors ; Multicenter Studies as Topic ; Randomized Controlled Trials as Topic
    Chemische Substanzen Factor Xa Inhibitors ; Rivaroxaban (9NDF7JZ4M3) ; Vitamin K (12001-79-5)
    Sprache Englisch
    Erscheinungsdatum 2020-03-25
    Erscheinungsland United States
    Dokumenttyp Clinical Trial Protocol ; Journal Article
    ZDB-ID 80026-0
    ISSN 1097-6744 ; 0002-8703
    ISSN (online) 1097-6744
    ISSN 0002-8703
    DOI 10.1016/j.ahj.2020.03.018
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  4. Artikel ; Online: Apixaban in patients with atrial fibrillation.

    Connolly, Stuart J / Eikelboom, John / Joyner, Campbell / Diener, Hans-Christoph / Hart, Robert / Golitsyn, Sergey / Flaker, Greg / Avezum, Alvaro / Hohnloser, Stefan H / Diaz, Rafael / Talajic, Mario / Zhu, Jun / Pais, Prem / Budaj, Andrzej / Parkhomenko, Alexander / Jansky, Petr / Commerford, Patrick / Tan, Ru San / Sim, Kui-Hian /
    Lewis, Basil S / Van Mieghem, Walter / Lip, Gregory Y H / Kim, Jae Hyung / Lanas-Zanetti, Fernando / Gonzalez-Hermosillo, Antonio / Dans, Antonio L / Munawar, Muhammad / O'Donnell, Martin / Lawrence, John / Lewis, Gayle / Afzal, Rizwan / Yusuf, Salim

    The New England journal of medicine

    2011  Band 364, Heft 9, Seite(n) 806–817

    Abstract: Background: Vitamin K antagonists have been shown to prevent stroke in patients with atrial fibrillation. However, many patients are not suitable candidates for or are unwilling to receive vitamin K antagonist therapy, and these patients have a high ... ...

    Abstract Background: Vitamin K antagonists have been shown to prevent stroke in patients with atrial fibrillation. However, many patients are not suitable candidates for or are unwilling to receive vitamin K antagonist therapy, and these patients have a high risk of stroke. Apixaban, a novel factor Xa inhibitor, may be an alternative treatment for such patients.
    Methods: In a double-blind study, we randomly assigned 5599 patients with atrial fibrillation who were at increased risk for stroke and for whom vitamin K antagonist therapy was unsuitable to receive apixaban (at a dose of 5 mg twice daily) or aspirin (81 to 324 mg per day), to determine whether apixaban was superior. The mean follow up period was 1.1 years. The primary outcome was the occurrence of stroke or systemic embolism.
    Results: Before enrollment, 40% of the patients had used a vitamin K antagonist. The data and safety monitoring board recommended early termination of the study because of a clear benefit in favor of apixaban. There were 51 primary outcome events (1.6% per year) among patients assigned to apixaban and 113 (3.7% per year) among those assigned to aspirin (hazard ratio with apixaban, 0.45; 95% confidence interval [CI], 0.32 to 0.62; P<0.001). The rates of death were 3.5% per year in the apixaban group and 4.4% per year in the aspirin group (hazard ratio, 0.79; 95% CI, 0.62 to 1.02; P=0.07). There were 44 cases of major bleeding (1.4% per year) in the apixaban group and 39 (1.2% per year) in the aspirin group (hazard ratio with apixaban, 1.13; 95% CI, 0.74 to 1.75; P=0.57); there were 11 cases of intracranial bleeding with apixaban and 13 with aspirin. The risk of a first hospitalization for cardiovascular causes was reduced with apixaban as compared with aspirin (12.6% per year vs. 15.9% per year, P<0.001). The treatment effects were consistent among important subgroups.
    Conclusions: In patients with atrial fibrillation for whom vitamin K antagonist therapy was unsuitable, apixaban reduced the risk of stroke or systemic embolism without significantly increasing the risk of major bleeding or intracranial hemorrhage. (Funded by Bristol-Myers Squibb and Pfizer; ClinicalTrials.gov number, NCT00496769.).
    Mesh-Begriff(e) Aged ; Aged, 80 and over ; Aspirin/adverse effects ; Aspirin/therapeutic use ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy ; Double-Blind Method ; Embolism/epidemiology ; Embolism/prevention & control ; Factor Xa Inhibitors ; Female ; Fibrinolytic Agents/adverse effects ; Fibrinolytic Agents/therapeutic use ; Hemorrhage/chemically induced ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Pyrazoles/adverse effects ; Pyrazoles/therapeutic use ; Pyridones/adverse effects ; Pyridones/therapeutic use ; Risk Factors ; Stroke/epidemiology ; Stroke/prevention & control
    Chemische Substanzen Factor Xa Inhibitors ; Fibrinolytic Agents ; Pyrazoles ; Pyridones ; apixaban (3Z9Y7UWC1J) ; Aspirin (R16CO5Y76E)
    Sprache Englisch
    Erscheinungsdatum 2011-03-03
    Erscheinungsland United States
    Dokumenttyp Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMoa1007432
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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