TPTThrombosis Prevention Trial | |
| Authors: | (a) Meade TW
(b) Meade TW, Roderick PJ, Brennan PJ, Wilkes HC, Kelleher CC (c) Meade TW, Miller GJ (d) Richards M, Meade TW, Peart S, Brennan PJ, Mann AH (e) The Medical Research Council\'s General Practice Research Framework |
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| Titles: | (a) Low-dose warfarin and low-dose aspirin in the primary prevention of ischemic heart disease
(b) Extra-cranial bleeding and other symptoms due to low dose aspirin and low intensity oral anticoagulation (c) Combined use of aspirin and warfarin in primary prevention of ischemic heart disease in men at high risk (d) Is there any evidence for a protective effect of antithrombotic medication on cognitive function in men at risk of cardiovascular disease? Some preliminary functions (e) Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk |
| References: | (a) Am J Cardiol 1990;65(suppl C):7C-11C
(b) Thromb Haemost 1992;68:1-6 (c) Am J Cardiol 1995;75:23B-6B (d) J Neurol Neurosurg Psychiatry 1997;62:269-72 (e) Lancet 1998;351:233-41 |
| Disease: | Ischaemic heart disease (IHD) |
| Purpose: | To investigate the effect of low-dose warfarin and low-dose aspirin on the incidence of IHD in men at high risk |
| Study Design: | Randomised, double-blind, placebo- controlled, factorial |
| Follow-up: | 5 years (minimum) |
| Patients: | 5085 men, mean age 57 years, in the top 20% of the IHD risk score distribution entered the factorial stage (1277 warfarin plus aspirin, 1268 warfarin, 1268 aspirin, 1272 placebo) |
| Treatmentregimen: | Warfarin, 2.5 mg/day increasing by 0.5 mg/day or 1.0 mg/day at monthly intervals until the appropriate dose has been achieved for each individual ( mean dose 4.1 mg/day), plus controlled-release aspirin, 75 mg/day, warfarin plus aspirin placebo, aspirin |
| Results: | Warfarin significantly reduced all IHD by 21% compared to aspirin alone or placebo (p = 0.02), mainly due to a 39% (p = 0.003) reduction in fatal events, so that warfarin reduced all-cause mortality by 17% (p = 0.04). The main effect of aspirin was a significant reduction in all IHD of 20% (p = 0.04), almost entirely due to a 32% reduction in nonfatal events (p = 0.004). Absolute reductions in all IHD were 2.6/1000 person-years with warfarin and 2.3/1000 person-years with aspirin. Warfarin reduced all IHD by 34% compared to placebo (p = 0.006). In a subgroup of 405 men, verbal fluency and mental flexibility were significantly better in subjects taking antithrombotic medication than in those taking placebo |
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