Comparison of Aspirin and Naoxintong Capsule (脑心通胶囊) with Adjusted-Dose Warfarin in Elderly Patients with High-Risk of Non-Valvular Atrial Fibrillation and Genetic Variants of Vitamin K Epoxide Reductase

Huan Wang; Xiao-kai Zhou; Li-fan Zheng; Xiao-ying Wu; Hui Chen

doi:10.1007/s11655-015-2443-4

Your Location：

Home >

Browse articles >

Comparison of Aspirin and Naoxintong Capsule (脑心通胶囊) with Adjusted-Dose Warfarin in Elderly Patients with High-Risk of Non-Valvular Atrial Fibrillation and Genetic Variants of Vitamin K Epoxide Reductase

Updated：2021-08-27

- Comparison of Aspirin and Naoxintong Capsule (脑心通胶囊) with Adjusted-Dose Warfarin in Elderly Patients with High-Risk of Non-Valvular Atrial Fibrillation and Genetic Variants of Vitamin K Epoxide Reductase
- Chinese Journal of Integrative Medicine Vol. 24, Issue 4, Pages: 247-253(2018)
- Affiliations：
  
  1. Department of Internal Medicine, Fujian Provincial Cardiovascular Disease Institute, Provincial Clinical College of Fujian Medical University,Fuzhou,China
  2. Cardiovascular Internal Medicine, Quzhou People’s Hospital of Zhejiang Province,Zhejiang Province,Quzhou,China
  3. Cardiovascular Internal Medicine, the Affiliated Hospital in Putian College of Fujian Province,Fujian Province,Putian,China
- Author bio：
- Funds：
- DOI：10.1007/s11655-015-2443-4
  CLC：
- Published：2018，
  
  Published Online：26 February 2016，
Scan for full text
Wang, H., Zhou, Xk., Zheng, Lf. et al. Comparison of Aspirin and Naoxintong Capsule (脑心通胶囊) with Adjusted-Dose Warfarin in Elderly Patients with High-Risk of Non-Valvular Atrial Fibrillation and Genetic Variants of Vitamin K Epoxide Reductase., Chin. J. Integr. Med. 24, 247–253 (2018). https://doi.org/10.1007/s11655-015-2443-4

Huan Wang, Xiao-kai Zhou, Li-fan Zheng, et al. Comparison of Aspirin and Naoxintong Capsule (脑心通胶囊) with Adjusted-Dose Warfarin in Elderly Patients with High-Risk of Non-Valvular Atrial Fibrillation and Genetic Variants of Vitamin K Epoxide Reductase. [J]. Chinese Journal of Integrative Medicine 24(4):247-253(2018)
Wang, H., Zhou, Xk., Zheng, Lf. et al. Comparison of Aspirin and Naoxintong Capsule (脑心通胶囊) with Adjusted-Dose Warfarin in Elderly Patients with High-Risk of Non-Valvular Atrial Fibrillation and Genetic Variants of Vitamin K Epoxide Reductase., Chin. J. Integr. Med. 24, 247–253 (2018). https://doi.org/10.1007/s11655-015-2443-4 DOI：

Huan Wang, Xiao-kai Zhou, Li-fan Zheng, et al. Comparison of Aspirin and Naoxintong Capsule (脑心通胶囊) with Adjusted-Dose Warfarin in Elderly Patients with High-Risk of Non-Valvular Atrial Fibrillation and Genetic Variants of Vitamin K Epoxide Reductase. [J]. Chinese Journal of Integrative Medicine 24(4):247-253(2018) DOI： 10.1007/s11655-015-2443-4.

摘要

To compared the therapeutic effect of a Chinese patent medicine Naoxintong Capsule (脑心通胶囊

NXT) and aspirin with adjusted-dose warfarin in Chinese elderly patients (over 65 years) with nonvalvular atrial fibrillation (NVAF) and genetic variants of vitamin K epoxide reductase (VKORC1)

who are at high-risk of thromboembolism. A total of 151 patients

with NVAF and AA genotype of VKORC1-1639 (a sensitive genotype to warfarin) and a CHA2DS2-VASc clinical risk score of 2 or above

were chosen for this study. Patients were randomized into two groups and orally treated with a combination of aspirin (100 mg/day) and NXT (1.6 g thrice a day) or adjusted-dose warfarin [international normalized ratio 2.0–3.0). The primary end points including ischemic stroke and death as well as the secondary end points including hemorrhage events were followed up for at least 1 year. Baseline clinical data and the rates of primary end points were similar between groups. However

the rate of serious bleeding (secondary event) in the combination therapy group was lower than that in the adjusted-dose warfarin group (0% vs. 7.9%

odds ratio: 0.921

95% confidence interval: 0.862–0.984

P=0.028). Aspirin combined with NXT and warfarin displayed comparable rates of primary end point including ischemic stroke and all-cause death during the 1-year follow-up. However

as compared with warfarin

the combination therapy reduced the rate of serious bleeding. Therefore

aspirin combined with NXT might provide an alternative pharmacotherapy in preventing ischemic stroke for elderly patients with NAVF who cannot tolerate warfarin. (No. ChiCTR-TRC-13003596)

Abstract

To compared the therapeutic effect of a Chinese patent medicine Naoxintong Capsule (脑心通胶囊

NXT) and aspirin with adjusted-dose warfarin in Chinese elderly patients (over 65 years) with nonvalvular atrial fibrillation (NVAF) and genetic variants of vitamin K epoxide reductase (VKORC1)

who are at high-risk of thromboembolism. A total of 151 patients

with NVAF and AA genotype of VKORC1-1639 (a sensitive genotype to warfarin) and a CHA2DS2-VASc clinical risk score of 2 or above

the rate of serious bleeding (secondary event) in the combination therapy group was lower than that in the adjusted-dose warfarin group (0% vs. 7.9%

odds ratio: 0.921

95% confidence interval: 0.862–0.984

P=0.028). Aspirin combined with NXT and warfarin displayed comparable rates of primary end point including ischemic stroke and all-cause death during the 1-year follow-up. However

as compared with warfarin

the combination therapy reduced the rate of serious bleeding. Therefore

aspirin combined with NXT might provide an alternative pharmacotherapy in preventing ischemic stroke for elderly patients with NAVF who cannot tolerate warfarin. (No. ChiCTR-TRC-13003596)

关键词

Atrial Fibrillationantithrombotic therapygenetic variantsWarfarinaspirin combined with NaoxintongChinese MedicineAlternative Medicine

Keywords

Atrial Fibrillationantithrombotic therapygenetic variantsWarfarinaspirin combined with NaoxintongChinese MedicineAlternative Medicine

references

Heeringa J, van der Kuip DA, Hofman A, Kors JA, van Herpen G, Stricker BH, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27:949–953.

Dayi H, Yihong S, Ziqiang Z, Kuibao L, Yongbin N, Guang Y, et al. The case-control study of the risk factors of stroke in Chinese people with non-valvular atrial fibrillation. J Intern Med 2003;42:157–161.

Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007;146:857–867.

The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med 1990;323:1505–1511.

The efficacy of aspirin in patients with atrial fibrillation. Analysis of pooled data from 3 randomized trials. The Atrial Fibrillation Investigators. Arch Intern Med 1997;157:1237–1240.

European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, et al; ESC Committee for Practice Guidelines. Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369–2429.

January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014;64:e1–e76.

Yuan HY, Chen JJ, Lee MT, Wung JC, Chen YF, Charng MJ, et al. A novel functional VKORC1 promoter polymorphism is associated with inter-individual and inter-ethnic differences in warfarin sensitivity. Hum Mol Genet 2005;14:1745–1751.

Gao Q, Fu X, Wei JW, Chen X, Huang Y, Wang J, et al. China QUEST Study Investigators. Use of oral anticoagulation among stroke patients with atrial fibrillation in China: the China QUEST (Quality evaluation of stroke care and treatment) registry study. Int J Stroke 2013;8:150–154.

Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 2010;137:263–272.

Zhang WP, Chen H, Luo J, Wu XY. Influence of CYP2C9 1061 A/C and VKORC1 1639 G/A polymorphisms on waffarin dose. J Med Mol Bid 2007;4:396–400.

Lee SC, NG SS, Oldnburg J, Chong PY, Rost S, Guo JY, et al. Interethnic variability of warfarin maintenance requirement is explained by VKORC1 genotype in an Asian population. Clin Pharmacol Ther 2006;79:197–205.

Zheng LF, Chen H. Investigation of anticoagulation therapy for elderly patients with high risk of nonvanular atrial fibrillation. Clin J Clin (Electr ed) 2012;6:874–878.

Su L, Li Y, Lv B, Ji H, Ding H, Hu L, et al. Clinical study on Naoxintong capsule for stroke recovery of qi-deficiency and blood-stasis syndrome. China J Chin Mater Med (Chin) 2011;36:1530–1533.

Wang J, Chu FY, Li J, Yao KW, Zhong JB, Zhou KH, et al. Study on syndrome element characteristics and its correlation with coronary angiography in 324 patients with coronary heart disease. Chin J Integr Med 2008;14:274–280.

Tian JF, Li JD, Lei Y. Clinical features of acute myocardial infarction inpatients in 26 level three class A Chinese medicine hospitals in China and the investigation of treatment. Chin J Integr Tradit West Med (Chin) 2012;32:329–332.

Chen BJ, Pan ZQ, Su XX. Study on changes of TCM syndrome in patients with coronary heart disease before and after intervention treatment. Chin J Integr Tradit West Med (Chin) 2007;27:689–691.

Lardizabal JA, Joshi BK, Ambrose JA. The balance between anti-ischemic efficacy and bleeding risk of antithrombotic therapy in percutaneous coronary intervention: a yin-yang paradigm. J Invasive Cardiol 2010;22:284–292.

Zhang H, Wang WR, Lin R, Zhang JY, Ji QL, Lin QQ, et al. Buyang Huanwu Decoction ameliorates coronary heart disease with qi deficiency and blood stasis syndrome by reducing CRP and CD40 in rats. J Ethnopharmacol 2010;130:98–110.

Zhou GY, Hu XQ, Chen XH, Su XW, Qu PX. Experimental study on effect of Buchang Naoxintong containing serum for antagonizing hypoxia-induced apoptosis of cortical neurons. Chin J Integr Tradit West Med (Chin) 2007;27:835–838.

Chen D, Lu P, Zhang FB, Tang SH, Yang HJ. Molecular mechanism research on simultaneous therapy of brain and heart based on data mining and network analysis. Chin J Integr Tradit West Med (Chin) 2013;38:91–98.

Mega JL, Walker JR, Ruff CT, Vandell AG, Nordio F, Deenadayalu N, et al. Genetics and the clinical response to warfarin and edoxaban: findings from the randomised, double-blind ENGAGE AF-TIMI 48 trial. Lancet 2015;365: 2280–2287.

Wang C, Yang Z, Wang C, Wang Y, Zhao X, Liu L, et al. Significant underuse of warfarin in patients with nonvalvular atrial fibrillation: results from the china national stroke registry. J Stroke Cerebrovasc Dis 2014;23:1157–1163.

Connolly SJ, Pogue J, Eikelboom J, Flaker G, Commerford P, Franzosi MG, et al; ACTIVE W Investigators. Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation 2008;118:2029–2037.

Mega JL, Close SL, Wiviott SD. Cytochrome p-450 polymorphisms and response to clopidogrel. N Engl J Med 2009;360:354–362.

Chen H, Yan W, Wu XY, Luo JW, Li CD. Relationships of blood stasis syndrome, CYP2C19 gene polymorphism with clopidogrel resistance and post-PCI prognosis. Chin J Integr Tradit West Med (Chin) 2010;30:1245–1249.

Jang JS, Cho KI, Jin HY, Seo JS, Yang TH, Kim DK, et al. Meta-analysis of cytochrome P450 2C19 polymorphism and risk of adverse clinical outcomes among coronary artery disease patients of different ethnic groups treated with clopidogrel. Am J Cardiol 2012;110:502–508.

SJ Connolly, MD Ezekowitz, S Yusuf, the RE-LY Steering Committee and Investigators, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139–1151.

MR Patel, KW Mahaffey, J Garg, the ROCKET AF Investigators, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883–891.

CB Granger, JH Alexander, JJ McMurray. the ARISTOTLE Committees and Investigators, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981–992.

RP Giugliano, CT Ruff, E Braunwald, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013;369:2093–2104.

Chen DK, Zhang HQ, Zhang JH. Intervening effect of Naoxintong on anti-platelet treatment with aspirin. Chin J Integr Tradit West Med (Chin) 2008;28:843–846.

Chen C, Venketasubramanian N, Gan RN, Lambert C, Picard D, Chan BP, et al. Danqi Piantang Jiaonang (DJ), a traditional Chinese medicine, in poststroke recovery. Stroke 2009;40:859–863.

Chen DK, Zhang HQ, Zhang JH. Intervening effect of Naoxintong on anti-platelet treatment with aspirin. Chin J Integr Tradit West Med (Chin) 2008;28:843–846.

Huang MW, Wang H, Zhong WJ, Wu XY, Chen H. Chinese herbal medicine Naoxintong Capsule combined with dual antiplatelet therapy in a rat model of coronary microembolization induced by homologous microthrombi. J Chin Integr Med (Chin) 2011;9:38–48.

Wang H, Zhong WJ, Huang MW, Wu XY, Chen H. Efficacy of dual antiplatelet therapy combined with Naoxintong Capsules following coronary microembolization induced by homologous microthrombi in rats. Chin J Integr Med 2011;17:917–924.

FULL TEXT LINK

More>

Views

Downloads

CSCD

Alert me when the article has been cited

Submit

Tools

Publicity Resources

The current acceptance, accessibility and recognition of Chinese and Ayurvedic medicine in the United States in the public, governmental, and industrial sectors

Association between genetic variants and characteristic symptoms of type 2 diabetes: A matched case-control study

Future view and development of immunology: Exploring the immunology based on Chinese medicine and culture

Cost-effectiveness analysis of combined Chinese medicine and Western medicine for ischemic stroke patients

Objective tongue inspection on 142 liver cancer patients with damp-heat syndrome

Related Author

No data

Related Institution

Asian Medicine and Acupuncture Research, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill

Skin Research Institute, AMOREPACIFIC Corporation, Yongin-si, Gyeonggi

Department of Nursing, Tianjin University of Traditional Chinese Medicine

Department of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine

Department of Biochemical Engineering, School of Chemical Engineering and Technology, Key Laboratory of Systems Bioengineering, Ministry of Education, Tianjin University

Address：1 Caochang, xiyuan, Beijing, People's Republic of China Postal code：100091
Tel：010-62886827, 62877592 Fax：010-62874291
Technical support is provided by Beijing Founder electronics co., LTD 京ICP备05067934号-1 京公网安备11010802024621
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰