이 페이지는 자동 번역되었으며 번역의 정확성을 보장하지 않습니다. 참조하십시오 영문판 원본 텍스트의 경우.

Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial (WARCEF)

2014년 8월 29일 업데이트: Shunichi Homma, Columbia University

The purpose of this study is to determine which of two treatments, Warfarin or aspirin, is better for preventing death and stroke in patients with poor heart function.

We are now transitioning into the sub-analysis part of the WARCEF patient data.

The study has recently completed data analysis for its Primary Aim. All randomized patients have completed their follow up. All study related procedure as per the protocol has been completed. We are now in the extension phase of the study to obtain more patient data to address further aims of the study. No new procedures are performed and data already in place at the sites will be collected (EKG and echocardiograms).

The aims for this study extension are:

  • To assess progression of cardiac dysfunction over time among heart failure patients
  • To correlate prognosis with cardiac dysfunction

연구 개요

상태

완전한

정황

개입 / 치료

상세 설명

Warfarin has proven effective in patients with ischemic heart disease, especially in the reduction of stroke, death and re-infarction following myocardial infarction, and in the reduction of stroke in atrial fibrillation. Warfarin is the most promising unstudied intervention in patients with cardiac failure. This randomized, double-blind, multi-center study will define optimal antithrombotic therapy for patients with cardiac (heart) failure and patients with low ejection fraction (EF). EF is the proportion of left ventricular volume emptied during systole. It reliably measures left ventricular systolic function.

With the rapidly increasing numbers of elderly patients with heart failure, this study has important public health implications. The study will determine which of two commonly used treatments Warfarin, an anticoagulant, or aspirin, a drug which affects platelet function is better for preventing death and stroke in patients with low ejection fraction.

연구 유형

중재적

등록 (실제)

2305

단계

  • 3단계

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 장소

  • 미국
    • Arizona
      • Tucson, Arizona, 미국
        • University of Arizona Health Sciences Center
      • Tucson, Arizona, 미국
        • Southern Arizona Veterans Affairs Medical Center
    • California
      • Santa Clara, California, 미국
        • Santa Clara Medical Center
      • West Los Angeles, California, 미국
        • West Los Angeles Veterans Affairs Medical Center
    • Colorado
      • Denver, Colorado, 미국
        • Denver Health Medical Center
      • Denver, Colorado, 미국
        • Denver Veterans Affairs Medical Center
    • District of Columbia
      • Washington, District of Columbia, 미국, 20037
        • George Washington University
    • Florida
      • Jacksonville, Florida, 미국
        • Mayo Clinic Transplant Center
      • Melbourne, Florida, 미국
        • Melbourne Internal Medicine Associates
      • Miami, Florida, 미국
        • Jackson Memorial Hospital/U. of Miami
      • Miami, Florida, 미국
        • Mercy Research Institute
      • Tamarac, Florida, 미국
        • Cardiovascular Consultants of South Florida
    • Georgia
      • Atlanta, Georgia, 미국
        • Morehouse School of Medicine
      • Gainesville, Georgia, 미국
        • Northeast Georgia Heart Center
    • Illinois
      • Chicago, Illinois, 미국
        • University of Illinois at Chicago
      • Peoria, Illinois, 미국
        • Methodist Heart, Lung and Vascular Institute
    • Kentucky
      • Lexington, Kentucky, 미국
        • University of Kentucky
      • Louisville, Kentucky, 미국
        • University of Louisville
      • Louisville, Kentucky, 미국
        • Louisville Veterans Affairs Medical Center
    • Louisiana
      • Metairie, Louisiana, 미국
        • Gulf Regional Research, LLC
      • Shreveport, Louisiana, 미국
        • LSU Health Sciences Center
    • Massachusetts
      • Burlington, Massachusetts, 미국
        • Lahey Clinic
    • Michigan
      • Detroit, Michigan, 미국
        • Veterans Affairs Medical Center
      • Muskegon, Michigan, 미국
        • Mercy Health Partners
    • Nevada
      • Reno, Nevada, 미국
        • Reno Veterans Affairs Medical Center
    • New Hampshire
      • Concord, New Hampshire, 미국
        • Concord Hospital
    • New Jersey
      • New Brunswick, New Jersey, 미국
        • UMDNJ - New Brunswick
      • Newark, New Jersey, 미국
        • University of Medicine and Dentistry of New Jersey
    • New York
      • Albany, New York, 미국
        • Albany Medical College
      • Buffalo, New York, 미국
        • Buffalo General Hospital
      • Buffalo, New York, 미국
        • Kaleida Health Millard Fillmore Hospital
      • Cedarhurst, New York, 미국
        • Five Towns Neuroscience Research
      • New Hyde Park, New York, 미국
        • Long Island Jewish Medical Center
      • New York, New York, 미국
        • Columbia University Medical Center
      • New York, New York, 미국
        • Mount Sinai Medical Center
      • New York, New York, 미국, 10032
        • Columbia University, New York Presbyterian Hospital PH 3-342
      • Northport, New York, 미국
        • Northport Veterans Affairs Medical Center
      • Rochester, New York, 미국
        • University of Rochester Medical Center
    • North Carolina
      • Chapel Hill, North Carolina, 미국
        • University of North Carolina at Chapel Hill
    • Ohio
      • Cleveland, Ohio, 미국
        • MetroHealth Medical Center
    • Oklahoma
      • Oklahoma City, Oklahoma, 미국
        • Oklahoma City Veterans Affairs Medical Center
    • Pennsylvania
      • Allentown, Pennsylvania, 미국
        • LeHigh Valley Hospital
      • Beaver, Pennsylvania, 미국
        • Tri-State Medical Group Cardiology
      • Leetsdale, Pennsylvania, 미국
        • Sewickley Valley Medical Group, Cardiology
      • Philadelphia, Pennsylvania, 미국
        • Hospital of the University of Pennsylvania
      • Philadelphia, Pennsylvania, 미국
        • Temple University Hospital
      • Philadelphia, Pennsylvania, 미국
        • Albert Einstein Medical Center
      • Philadelphia, Pennsylvania, 미국
        • Penn Presbyterian Medical Center
    • South Dakota
      • Fort Meade, South Dakota, 미국
        • Black Hills Health Care System
    • Texas
      • Ft. Sam Houston, Texas, 미국
        • Brooke Army Medical Center MCHE - MDC Cardiology Service
      • Houston, Texas, 미국
        • Michael E. DeBakey Veterans Affairs Medical Center-MEDVAMC
    • Virginia
      • Salem, Virginia, 미국
        • Salem Vamc
    • West Virginia
      • Huntington, West Virginia, 미국
        • Huntington Veterans Affairs Medical Center
    • Wisconsin
      • Madison, Wisconsin, 미국
        • William S. Middleton Memorial Veterans Hospital
  • 캐나다
    • Alberta
      • Lethbridge, Alberta, 캐나다
        • Center for Neurologic Research
    • Manitoba
      • Winnipeg, Manitoba, 캐나다
        • St. Boniface General Hospital
    • New Brunswick
      • Saint John, New Brunswick, 캐나다
        • Saint John Regional Hospital
    • Nova Scotia
      • Halifax, Nova Scotia, 캐나다
        • QE II Health Sciences Centre
    • Ontario
      • London, Ontario, 캐나다
        • London Health Sciences Centre
      • Ottawa, Ontario, 캐나다
        • Ottawa Heart Institute
      • Rexdale, Ontario, 캐나다
        • Etobicoke Cardiac Research Centre
      • Toronto, Ontario, 캐나다
        • St. Michael's Hospital
    • Quebec
      • Montreal, Quebec, 캐나다
        • Montreal Heart Institute
      • Montreal, Quebec, 캐나다
        • Montreal General Hospital

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

18년 이상 (성인, 고령자)

건강한 자원 봉사자를 받아들입니다

아니

연구 대상 성별

모두

설명

Inclusion Criteria

  • Cardiac EF <=35% by radionuclide ventriculography, left ventriculography or quantitive echocardiographic measurement or an echocardiographic Wall Motion Index of <=1.2, within three months of enrollment. The patient's clinical cardiac state at enrollment should be similar to their state at the time of the qualifying echocardiogram. The qualifying left ventricular function measurement must be obtained at least three months after an MI, coronary bypass grafting, PTCA, and at least one month after pacemaker insertion. Patients scheduled for mitral valve repair should have qualifying echo after surgery.
  • Modified Rankin score <=4.
  • Patient must be taking ACE inhibitors. If intolerant of ACE inhibitor, patient must be on angiotensin II receptor blockers or hydralazine and nitrates.
  • Patient is able to follow an outpatient protocol (requiring monthly blood tests and clinic visits every four months for the duration of the study) and is available by telephone.
  • Patient understands the purpose and requirements of the study, can make him/herself understood, and has provided informed consent.
  • Patients with recent stroke or TIA within twelve (12) months will be eligible to be included in the recent stroke (RS) subgroup.
  • Chronic CHF patients (NYHA I * IV) admitted to the hospital can be randomized prior to discharge if the patient is stable, taking oral medications for 24 hours and ambulatory at the time of discharge. Stable New York Heart Association Class IV patients will be eligible for randomization.

Exclusion Criteria

  • The presence of any of the following unequivocal cardiac sources of embolism: chronic or paroxysmal AF, mechanical valve, endocarditis, intracardiac mobile or pedunculated thrombus, and valvular vegetation.
  • Cyanotic congenital heart disease, Eisenmenger's syndrome.
  • Decompensated heart failure.
  • Cardiac surgery, angioplasty, or MI within the past 3 months prior to randomization.
  • A contraindication to the use of either warfarin or aspirin, e.g. active peptic ulcer disease, active bleeding diathesis, platelets <100,000*, hematocrit <30, INR >1.3 (if not on warfarin), clotting factor abnormality that increases the risk of bleeding, alcohol or substance abuse, severe gait instability, cerebral hemorrhage, systemic hemorrhage within the past year, severe liver impairment (AST >3x normal*, cirrhosis), any condition requiring regular use of non-steroidal anti-inflammatory agents, allergy to aspirin or warfarin, uncontrolled severe hypertension (systolic pressure >180 mm Hg or diastolic pressure > 110 mm Hg), positive stool guaiac not attributable to hemorrhoids, creatinine >3.0*. *on most recent test done within 30 days prior to randomization
  • Patient needs continuing therapy with intravenous heparin or low molecular weight heparin or a specific antiplatelet agent.
  • Dementia or psychiatric or physical problem that prevents the patient from following an outpatient program reliably.
  • Comorbid conditions that may limit survival to less than five years.
  • Pregnancy, or female of childbearing potential who is not sterilized or is not using a medically accepted form of contraception* (see procedure manual). *A pregnancy test is required for all women of childbearing age.
  • Enrollment in another study that would conflict with WARCEF.
  • Hospitalization for new diagnosis of onset CHF within the past one month or carotid endarterectomy or pacemaker insertion within the past one month prior to randomization .
  • Person under 18 years of age.

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

  • 주 목적: 방지
  • 할당: 무작위
  • 중재 모델: 병렬 할당
  • 마스킹: 더블

무기와 개입

참가자 그룹 / 팔
개입 / 치료
활성 비교기: aspirin
Aspirin: 325 mg per day
의약품: aspirin
325 mg per day
활성 비교기: warfarin
Warfarin: International Normalized Ratio (INR) 2.5-3.0; target INR 2.75
의약품: Warfarin
INR 2.5-3.0; target INR 2.75

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정
측정값 설명
기간
Event Rate Per 100 Patient Years for Composite Endpoint of Ischemic Stroke, Intracerebral Hemorrhage, or Death
기간: From date of randomization until the date of the first to occur of ischemic stroke, intracerebral hemorrhage, or death, up to 6 years
The time, in years, from randomization to the first to occur of ischemic stroke, intracerebral hemorrhage, or death, up to a maximum of 6 years. Event rate per 100 patient years = 100*(number of subjects with event)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1) of all randomized patients / 365.25.
From date of randomization until the date of the first to occur of ischemic stroke, intracerebral hemorrhage, or death, up to 6 years

2차 결과 측정

결과 측정
측정값 설명
기간
Event Rate Per 100 Patient-years for Composite Endpoint of Hospitalization for Heart Failure, Myocardial Infarction, Ischemic Stroke, Intracerebral Hemorrhage, or Death.
기간: From randomization to the first to occur of hospitalization for heart failure, myocardial infarction, ischemic stroke, intracerebral hemorrhage, or death, up to a maximum of 6 years.

The time, in years, from date of randomization to the date of the first to occur of hospitalization for heart failure, myocardial infarction, ischemic stroke, intracerebral hemorrhage, or death, up to 6 years.

Event rate per 100 patient years = 100*(number of subjects with event)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1) of all randomized patients / 365.25.
From randomization to the first to occur of hospitalization for heart failure, myocardial infarction, ischemic stroke, intracerebral hemorrhage, or death, up to a maximum of 6 years.

기타 결과 측정

결과 측정
측정값 설명
기간
Event Rate Per 100 Patient-years for Ischemic Stroke
기간: From date of randomization to date of ischemic stroke component of primary composite outcome, up to 6 years
Time, in years, from date of randomization to date of ischemic stroke component of primary composite outcome, up to 6 years. Event rate per 100 patient years = 100*(number of subjects with ischemic stroke)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1) of all randomized patients / 365.25.
From date of randomization to date of ischemic stroke component of primary composite outcome, up to 6 years
Event Rate Per 100 Patient-years for Intracerebral Hemorrhage
기간: From date of randomization to date of intracerebral hemorrhage component of primary composite outcome, up to 6 years
Time, in years, from date of randomization to date of intracerebral hemorrhage component of primary composite outcome. Event rate per 100 patient years = 100*(number of subjects with intracerebral hemorrhage)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1) of all randomized patients / 365.25.
From date of randomization to date of intracerebral hemorrhage component of primary composite outcome, up to 6 years
Event Rate Per 100 Patient-years for Death
기간: From date of randomization to date of death component of primary composite outcome, up to 6 years
Time, in years, from date of randomization to date of death component of primary composite outcome. Event rate per 100 patient years = 100*(number of subjects who died)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1) of all randomized patients / 365.25.
From date of randomization to date of death component of primary composite outcome, up to 6 years
Event Rate Per 100 Patient Years of Myocardial Infarction Component of Secondary Composite Outcome
기간: From date of randomization to date of myocardial infarction component of secondary composite outcome, up to 6 years
Time, in years, from date of randomization to date of myocardial infarction, up to 6 years. Includes only myocardial infarctions that occurred during follow-up, before any heart failure hospitalization. Event rate per 100 patient years = 100*(number of subjects with myocardial infarction)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1) of all randomized patients / 365.25.
From date of randomization to date of myocardial infarction component of secondary composite outcome, up to 6 years
Event Rate Per 100 Patient Years of Heart Failure Hospitalization Component of Secondary Composite Outcome.
기간: From date of randomization to date of heart failure hospitalization component of secondary composite outcome, up to 6 years
Time, in years, from date of randomization to date of heart failure hospitalization, up to 6 years. Includes hospitalizations for heart failure during follow-up that were not preceded by myocardial infarction. Event rate per 100 patient years = 100*(number of subjects with heart failure hospitalization)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1) of all randomized patients / 365.25.
From date of randomization to date of heart failure hospitalization component of secondary composite outcome, up to 6 years
Event Rate Per 100 Patient Years of Ischemic Stroke Component of Secondary Composite Outcome
기간: From date of randomization to date of ischemic stroke component of secondary composite outcome, up to 6 years
Ischemic stroke component of secondary composite endpoint. Includes only ischemic strokes that were not preceded by a myocardial infarction or heart failure hospitalization. The number of ischemic strokes that are components of the secondary outcome does not therefore match the number of ischemic strokes that are components of the primary outcome. Event rate per 100 patient years = 100*(number of subjects with ischemic stroke)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1)of all randomized patients / 365.25.
From date of randomization to date of ischemic stroke component of secondary composite outcome, up to 6 years
Event Rate Per 100 Patient Years of Intracerebral Hemorrhage Component of Secondary Composite Outcome
기간: From date of randomization to date of intracerebral hemorrhage component of secondary composite outcome, up to 6 years
Time, in years, from date of randomization to date of intracerebral hemorrhage component of secondary composite outcome. Includes only intracerebral hemorrhages not preceded by myocardial infarction or heart failure hospitalization. Event rate per 100 patient years = 100*(number of subjects with intracerebral hemorrhage)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1) of all randomized patients / 365.25.
From date of randomization to date of intracerebral hemorrhage component of secondary composite outcome, up to 6 years
Event Rate Per 100 Patient Years of Death Component of Secondary Composite Outcome
기간: From date of randomization to date of death component of secondary composite outcome, up to 6 years
Time, in years, from randomization to death component of secondary composite outcome. This measure counts only deaths that were not preceded by heart failure hospitalization, myocardial infarction, ischemic stroke, or intracerebral hemorrhage. Event rate per 100 patient years = 100*(number of subjects who died)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1) of all randomized patients / 365.25.
From date of randomization to date of death component of secondary composite outcome, up to 6 years
Rate Per 100 Patient Years of Major Hemorrhage
기간: From date of randomization until end of scheduled follow-up, up to 6 years
Rate/100 patient-years of major hemorrhage. Includes all major hemorrhages in any patient. Major hemorrhage was defined as intracerebral, epidural, subdural, subarachnoid, spinal intramedullary, or retinal hemorrhage; any other bleeding causing a decline in the hemoglobin level of more than 2 g per deciliter in 48 hours; or bleeding requiring transfusion of 2 or more units of whole blood, hospitalization, or surgical intervention. Event rate per 100 patient years = 100*(number of major hemorrhage events)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1) of all randomized patients / 365.25.
From date of randomization until end of scheduled follow-up, up to 6 years
Rate Per 100 Patient-years of Minor Hemorrhage.
기간: From date of randomization until the end of scheduled follow-up, up to 6 years
Rate per 100 patient years of minor hemorrhage. Includes all minor hemorrhages. Minor hemorrhage was defined as any non-major hemorrhage. Event rate per 100 patient years = 100*(number of minor hemorrhage events)/patient-years of follow-up. Patient years of follow-up = sum(date of conclusion of follow-up - date of randomization + 1)of all randomized patients / 365.25.
From date of randomization until the end of scheduled follow-up, up to 6 years

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

스폰서

Columbia University

협력자

National Institute of Neurological Disorders and Stroke (NINDS)

수사관

  • 수석 연구원: Shunichi Homma, M.D., Principal Cardiologist, Associate Chief, Division of Cardiology, and Director, Echocardiography Laboratories Professor of Medicine
  • 수석 연구원: Seamus Thompson, PhD, Statistical PI: Clinical Professor of Biostatistics and Neurology

간행물 및 유용한 링크

연구에 대한 정보 입력을 담당하는 사람이 자발적으로 이러한 간행물을 제공합니다. 이것은 연구와 관련된 모든 것에 관한 것일 수 있습니다.

일반 간행물

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작

2002년 10월 1일

기본 완료 (실제)

2011년 8월 1일

연구 완료 (실제)

2014년 7월 1일

연구 등록 날짜

최초 제출

2002년 7월 19일

QC 기준을 충족하는 최초 제출

2002년 7월 19일

처음 게시됨 (추정)

2002년 7월 22일

연구 기록 업데이트

마지막 업데이트 게시됨 (추정)

2014년 9월 5일

QC 기준을 충족하는 마지막 업데이트 제출

2014년 8월 29일

마지막으로 확인됨

2014년 8월 1일

추가 정보

이 연구와 관련된 용어

키워드

추가 관련 MeSH 약관

기타 연구 ID 번호

  • AAAC1093
  • CRC (NINDS)
  • U01NS039143-01 (미국 NIH 보조금/계약)
  • R01NS39154

이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .

구독하다