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BACKGROUND: A combination of low-dose aspirin with anticoagulants may provide better protection against thromboembolic events compared to anticoagulants alone in high-risk patients with atrial fibrillation. OBJECTIVE: Evaluation of the preventive efficacy against nonfatal thromboembolic events and vascular deaths of the combination of the oral anticoagulant fluindione and aspirin (100 mg) in patients with high-risk atrial fibrillation. METHODS: A multicenter, placebo-controlled, double-blind, randomized trial was conducted at 49 investigating centers in France. Atrial fibrillation patients with a previous thromboembolic event or older than 65 years and with either a history of hypertension, a recent episode of heart failure or decreased left ventricular function were included in the study. Patients were treated with fluindione plus placebo (i.e. anticoagulant alone) or fluindione plus aspirin (i.e. combination therapy), with an international normalized ratio target of between 2 and 2.6. The combined primary endpoint was stroke (ischemic or hemorrhagic), myocardial infarction, systemic arterial emboli or vascular death. The secondary endpoint was the incidence of hemorrhagic complications. RESULTS: The 157 participants (average age 74 years; 52% women; 42% with paroxysmal atrial fibrillation) were followed for an average of 0.84 years. Three nonfatal thromboembolic events were observed (1 in the anticoagulation group, 2 in the combination group) and 6 patients died (3 in the anticoagulation group, 3 in the combination group), none of them from a thromboembolic complication. However, 3 deaths were secondary to severe hemorrhagic complications (1 in the anticoagulation group, 2 in the combination group). Nonfatal hemorrhagic complications occurred more often in the combination group (n = 10, 13.1%) compared to the anticoagulation group (n = 1, 1.2%) (p = 0.003). CONCLUSION: The combination of aspirin with anticoagulant is associated with increased bleeding in elderly atrial fibrillation patients. The effect on thromboembolism and the overall balance of benefit to risk could not be accurately assessed in this study due to the limited number of ischemic events.

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BACKGROUND: A combination of low-dose aspirin (A) and anticoagulation (AC) may provide better protection against thromboembolic events compared with AC alone in high-risk patients with atrial fibrillation (AF). METHODS: We performed a multicentric placebo-controlled double blind-trial to test the preventive efficacy against thromboembolic events of the addition of aspirin (A) (100 mg) or placebo (P) to anticoagulant treatment in patients with high-risk atrial fibrillation. A total of 157 patients were included, with atrial fibrillation and previous thromboembolic event or older than 65 years with either a history of hypertension, a recent episode of heart failure or a left ventricular dysfunction. All patients received fluindione (F) and P or F and A, with an INR target between 2 and 2.6. The primary endpoint was a combined endpoint of stroke (ischaemic or haemorrhagic), myocardial infarction, systemic arterial emboli or vascular death. RESULTS: The study had to be stopped prematurely owing to a too low recruitment rate. During follow-up (0.84 years) 3 non-fatal thromboembolic events were recorded (1P, 2A) and 6 patients died (3P, 3A), none of them from a thromboembolic complication. However, 3 deaths were secondary to severe haemorrhagic complications (1P, 2A). Non-fatal haemorrhagic complications occurred more often in group A (n = 10, 13.1 pour cent) compared with group P (n = 1, 1.2 pour cent), p = 0.003. CONCLUSION: The FFAACS study was not able to show any therapeutic benefit from the addition of aspirin to anticoagulant in patients with high-risk AF. Such a combination increased the incidence rate of bleeding complications, which therefore greatly reduces its potential overall benefit.

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In the interval 1985-1994, in the Iasi district, the reported cases of viral hepatitis (VH) have recorded annual morbidity rates ranging between 67/100,000 inhabitants in 1993 and 373/100,000 in 1990. VH attributed to HAV and HBV has represented, with yearly differences, 62% to 94% of all cases. Posttransfusion viral hepatitis (PTVH) has determined a morbidity of 0.51/100,000 inhabitants in 1986 and 8.34/100,000 in 1994. PTVH without AgHBs ranged from 16.3% in 1993 to 94.0% in 1987, as compared to 6.0% in 1987 and 1988 and 75.0% in 1985 for PTVH with AgHBs. In the interval under study 70.9% of the PTVH cases were most likely determined by HCV and 28.9% by HBV (AgHBs+). From all PTVH cases, 64.0% were from urban areas, 59.3% were females, 92.5% belonged to over 20 years age groups, and 31.3% were industrial workers, the remainder belonging to other 5 occupational groups. In 241 patients (18.2%) admitted for liver disorders, posttransfusion hepatitis included, AcHCV was present in 39.4%, of which 45.2% belonged to the age groups 20-60 years. The results of some investigations carried out on 4471 blood donors (72.4% males, 85.4% aged between 21 ad 50 years, 86.4% from urban areas, 62.1% workers in industry and building) are presented. Out of these, 217 (4.9%) presented to hepatitis C virus (AcHCV). Occupational distribution of AcHCV possessors shows that 44.2% are workers in the heavy industry, 14.8% in the light industry and 12.9% unemployed. Sera were tested by Monolisa New Antigens, and those with AcHCV were reassessed with Monolisa, Murex anti HCV, ORTO-HCV 3.0 and confirmed by Immunoblot DECISCAN, with 5 antigens.

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An epidemiological screening of 8011 industrial workers and 7090 pupils made possible the active detection of some risk factors carriers and of those individuals with borderline essential arterial hypertension (BEAHT) and essential arterial hypertension disease (EAHTD). It was noticed that the association of 2-4 risk factors is more common in the subjects with BEAHT or EAHTD, fact indicating their increased aggressivity in the various types of associations present in the same carrier. In the worker series a prevalence of 16.2%-18.0% for BEAHT and 6.3%-7.1% for EAHTD as compared to 4.3%-6.0% and 4.9%-5.3%, respectively, in the pupil series were recorded. The epidemiological screening had a strong educational effect, reflected in an increased cooperation of the screened population, and revealed the fact that the risk factor carrier state and the increased arterial pressure levels were ignored, at long term, by 50-90% of the investigated subjects.

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The results of epidemiological observations on the evolution of viral hepatitis in the Iasi district in the interval 1971-1990 are presented. A mean morbidity of 251.2 cases/100,000 inhabitants, this being in most years under the national mean, was found. In 75.9% of all cases the infections caused by hepatitis viruses affected the age-groups 1-14 years, indicating a high incidence of hepatitis A... Hepatitis B had a more increased incidence in the children aged 0-1 year, then it decreased but was present in all age groups. Although recorded all year round, increases in the incidence of viral hepatitis A were noticed during fall and winter seasons, prevailing in the children and teenagers collectivities.

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