Anticoagulation therapy for @entity64 prevention in XXXX : how well do randomized trials translate into clinical practice?

@entity1 @entity64 @entity932 @entity548 @entity117 @entity1897 @entity1031 @entity955 @entity204 @entity1229 @entity385
CONTEXT: @entity1229 has been shown to be highly efficacious for preventing @entity1031 in @entity955 in randomized trials, but its effectiveness and safety in clinical practice is less clear. OBJECTIVE: To evaluate the effect of @entity1229 on risk of @entity1031 , @entity548 , and @entity204 in @entity955 within a usual care setting. DESIGN: Cohort study assembled between July 1, 1996, and December 31, 1997, and followed up through August 31, 1999. SETTING: Large integrated health care system in Northern California. @entity1 : Of 13,559 adults with nonvalvular @entity955 , 11,526 were studied, 43% of whom were @entity1 , mean age 71 years, with no known contraindications to anticoagulation at baseline. MAIN OUTCOMES: @entity385 , @entity1897 , @entity548 , and @entity204 according to @entity1229 use and comorbidity status, as determined by automated databases, review of medical records, and state mortality files. RESULTS: Among 11,526 @entity1 , 397 incident @entity1031 events (372 @entity385 , 25 @entity1897 ) occurred during 25,341 @entity1 -years of follow-up, and @entity1229 therapy was associated with a 51% (95% confidence interval [CI], 39%-60%) lower risk of @entity1031 compared with no @entity1229 therapy (either no antithrombotic therapy or @entity117 ) after adjusting for potential confounders and likelihood of receiving @entity1229 . @entity1229 was effective in reducing @entity1031 risk in the presence or absence of risk factors for @entity64 . A nested case-control analysis estimated a 64% reduction in odds of @entity1031 with @entity1229 compared with no antithrombotic therapy. @entity1229 was also associated with a reduced risk of all-cause mortality (adjusted hazard ratio, 0.69; 95% CI, 0.61-0.77). @entity932 was uncommon, but the rate was moderately higher among those taking vs those not taking @entity1229 (0.46 vs 0.23 per 100 @entity1 -years, respectively; P =.003, adjusted hazard ratio, 1.97; 95% CI, 1.24-3.13). However, @entity1229 therapy was not associated with an increased adjusted risk of nonintracranial major @entity548 . The effects of @entity1229 were similar when @entity1 with contraindications at baseline were analyzed separately or combined with those without contraindications (total cohort of 13,559). CONCLUSIONS: @entity1229 is very effective for preventing @entity385 in @entity1 with @entity955 in clinical practice while the absolute increase in the risk of @entity932 is small. Results of randomized trials of anticoagulation translate well into clinical care for @entity1 with @entity955 .
