Rationale and design of ACTIVE: the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events.

BACKGROUND: Atrial fibrillation (AF) is the most frequently occurring cardiac arrhythmia with often serious clinical consequences. Many patients have contraindications to anticoagulation, and it is often underused in clinical practice. The addition of clopidogrel to aspirin (ASA) has been shown to reduce vascular events in a number of high-risk populations. Irbesartan is an angiotensin receptor-blocking agent that reduces blood pressure and has other vascular protective effects. METHODS AND RESULTS: ACTIVE W is a noninferiority trial of clopidogrel plus ASA versus oral anticoagulation in patients with AF and at least 1 risk factor for stroke. ACTIVE A is a double-blind, placebo-controlled trial of clopidogrel in patients with AF and with at least 1 risk factor for stroke who receive ASA because they have a contraindication for oral anticoagulation or because they are unwilling to take an oral anticoagulant. ACTIVE I is a partial factorial, double-blind, placebo-controlled trial of irbesartan in patients participating in ACTIVE A or ACTIVE W. The primary outcomes of these studies are composites of vascular events. A total of 14000 patients will be enrolled in these trials. CONCLUSIONS: ACTIVE is the largest trial yet conducted in AF. Its results will lead to a new understanding of the role of combined antiplatelet therapy and the role of blood pressure lowering with an angiotensin II receptor blocker in patients with AF.

Surgical removal from the descending aorta of a floating thrombus caused by blunt chest trauma.

A 44-year-old woman presented with a recurrent peripheral embolism. Her past history was remarkable for blunt chest trauma 7 years before presentation. Transoesophageal echocardiography showed a floating mass in the descending aorta. Operative and pathological findings revealed an aged thrombus. Reliable diagnostic methods and appropriate treatment can prevent further embolic events.

[Thrombolysis by tissue plasminogen activator in acute myocardial infarct]. / Thrombolysis szöveti plasminogén aktivátorral akut myokardiális infarktusban.

The authors participated in the European multicenter investigation, ESPRIT, organized by the Wellcome Research Laboratories. Thrombolytic treatment by intravenous tissue plasminogen activator was performed in 25 patients with early (less than 6h) myocardial infarction. The efficacy of the treatment was controlled by repeat coronary arteriography at 60 minutes, at 90 minutes and at 24 hours of the tpA treatment. The infarct related artery was reperfused in 9/25 patients at 60 minutes, in 16/25 at 90 minutes and 17/18 at 24 hours. Four patients died after unsuccessful treatment or reocclusion. In two patients significant bleeding occurred at the puncture site but no transfusion was required. No other untoward effect was registered. The left ventricular function did not change significantly during the first day of infarction. It is concluded, that tpA is a safe thrombolytic agent in myocardial infarction. Its thrombolytic efficacy is similar to that of streptokinase.

A methodological report on household psychometric screening for retardation.

This report is a detailed description and analysis of the methods, problems, and results of mental testing carried out in the home as a phase of a community survey of mental retardation. A group of 409 individuals were tested, including a random sample of persons scoring in the lowest 10% of the developmental scales completed by the initial interviewers and a random sample of all persons in the interviewed households. Little testing of this type has been done in most other surveys of this nature; still fewer studies attempted testing in the home itself. The descriptive information on this successful project should be of value to other investigators who are interested in developing community-wide surveys.