***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND PURPOSE Although the efficacy of anticoagulant therapy for primary prevention of stroke in patients with nonvalvular atrial fibrillation ( NVAF ) has been established , efficacy of antiplatelet therapy for low-risk patients is disputable in Japanese patients because of the frequent hemorrhagic complications . We examined the efficacy and safety of aspirin therapy in Japanese patients with NVAF in a prospect i ve r and omized multicenter trial . METHODS Patients with NVAF were r and omized to an aspirin group ( aspirin at 150 to 200 mg per day ) or a control group without antiplatelet or anticoagulant therapy . Primary end points included cardiovascular death , symptomatic brain infa rct ion , or transient ischemic attack . RESULTS A total of 426 patients were r and omized to aspirin group and 445 to no treatment . The trial was stopped earlier because there were 27 primary end point events ( 3.1 % per year ; 95 % CI , 2.1 % to 4.6 % per year ) in the aspirin group versus 23 ( 2.4 % per year ; 95 % CI , 1.5 % to 3.5 % per year ) in the control group , suggesting a low possibility of superiority of the aspirin treatment for prevention of the primary end point . In addition , treatment with aspirin caused a marginally increased risk of major bleeding ( 7 patients ; 1.6 % ) compared with the control group ( 2 patients ; 0.4 % ; Fisher exact test P=0.101 ) . CONCLUSIONS For prevention of stroke in patients with NVAF , aspirin at 150 to 200 mg per day does not seem to be either effective or safe . Further prospect i ve studies are needed to determine the best preventive therapy for cerebrovascular events in Japanese patients with NVAF AIMS The Bleeding Academic Research Consortium ( BARC ) classification has been proposed by consensus to st and ardize bleeding endpoint definition and reporting in cardiovascular clinical trials . There are no prospect i ve studies on its prognostic impact . METHODS AND RESULTS We explored the association of BARC-defined bleeding with mortality and compared its prognostic value against two vali date d bleeding scales : the Thrombolysis in Myocardial Infa rct ion ( TIMI ) and the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries ( GUSTO ) scales . Non-coronary artery bypass graft (CABG)-related bleedings within the PRODIGY trial were prospect ively adjudicated by a blinded Clinical Event Committee and analysed according to multiple statistical modelling . At 2 years , bleeding occurred in 143 patients ( 7.1 % ) according to BARC Type 2 , 3 , or 5 ; in 50 patients ( 2.5 % ) according to TIMI minor or major ; and in 61 patients ( 3.1 % ) according to GUSTO moderate or severe . One hundred sixty-three patients died ( 8.1 % ) . After multivariable modelling , BARC Type 2 , 3 , or 5 bleeding was associated with increased 2-year mortality [ hazard ratio ( HR ) : 3.77 ; 95 % confidence interval ( CI ) : 2.37 - 5.98 ] . Bleeding Academic Research Consortium Type 3 or 5 was associated with an increased mortality rate at 2 years ( adjusted HR : 7.72 ; 95 % CI : 4.75 - 12.54 ) similar to that provided by TIMI ( HR : 7.64 , 95 % CI : 4.53 - 12.87 ) or GUSTO ( HR : 7.36 , 95 % CI : 4.38 - 12.34 ) criteria . CONCLUSIONS In a contemporary , all-comer percutaneous coronary intervention trial actionable BARC bleedings were associated with increased risk of mortality with BARC Type 3 or 5 bleedings providing a similar mortality risk to that posed by TIMI or GUSTO scales BACKGROUND atrial fibrillation ( AF ) is the commonest chronic arrhythmia with a prevalence of 9 % in octogenarians and accounts for 24 % of the stroke risk in this population . Although trials demonstrate reductions in stroke with warfarin , audit data show that it is still underused . However , anti-coagulation in the very elderly is not without risk . METHODS r and omised open labelled prospect i ve study of primary thromboprophylaxis for AF . Patients aged > 80 and < 90 were r and omised to receive dose-adjusted warfarin ( INR 2.0 - 3.0 ) or aspirin 300 mg .  All patients had permanent AF , were ambulant , had Folstein mini mental score > 25 and had no contraindications to either treatment . Follow-up was for 1 year with 3 monthly visits . The primary outcome measure was a comparative frequency of combined endpoints comprising death , thromboembolism , serious bleeding and withdrawal from the study .  RESULTS seventy-five patients ( aspirin 39 ; warfarin 36 ) were entered ( mean age 83.9 , 47 % male ) . There were significantly more adverse events with aspirin ( 13/39 ; 33 % ) than warfarin ( 2/36 ; 6 % ) , P = 0.002 . 10/13 aspirin  adverse events were caused by side effects and serious bleeding ; there were three deaths ( two aspirin , one warfarin ) . CONCLUSION dose-adjusted warfarin was significantly better tolerated with fewer adverse events than aspirin 300 mg in this elderly population . Although aspirin 75 mg may have been better tolerated , there is no evidence for efficacy in AF at this dose The primary objective of this study was to compare the safety of four fixed-dose regimens of edoxaban with warfarin in patients with non-valvular atrial fibrillation ( AF ) . In this 12-week , parallel-group , multicentre , multinational study , 1,146 patients with AF and risk of stroke were r and omised to edoxaban 30 mg qd , 30 mg bid , 60 mg qd , or 60 mg bid or warfarin dose-adjusted to a target international normalised ratio of 2.0 - 3.0 . The study was double-blind to edoxaban dose , but open-label to warfarin . Primary outcomes were occurrence of major and /or clinical ly relevant non-major bleeding and elevated hepatic enzymes and /or bilirubin .  Mean age was 65 + /- 8.7 years and 64.4 % were warfarin-naïve . Whereas major plus clinical ly relevant non-major bleeding occurred in 3.2 % of patients r and omised to warfarin , the incidence of bleeding was significantly higher with the edoxaban 60 mg bid ( 10.6 % ; p=0.002 ) and 30 mg bid regimens ( 7.8 % ; p=0.029 ) , but not with the edoxaban 60 mg qd ( 3.8 % ) or 30 mg qd regimens ( 3.0 % ) . For the same total daily dose of 60 mg , both bleeding frequency and trough edoxaban concentrations were higher in the 30-mg bid group than in the 60-mg qd group . There were no significant differences in hepatic enzyme elevations or bilirubin values among the groups . The safety profiles  of edoxaban 30 and 60 mg qd in patients with AF were similar to warfarin . In contrast , the edoxaban bid regimens were associated with more bleeding than warfarin . These results suggest that in this three-month study , edoxaban 30 or 60 mg qd are safe and well-tolerated We compared the transverse and longitudinal approaches to ultrasound‐guided  identification of the cricothyroid membrane , to determine which was faster and more successful . Forty‐two anaesthetists received a one‐hour structured training programme consisting of e‐learning , a lecture and h and s‐on training , and then applied both techniques in a r and omised , cross‐over sequence to obese females with body mass index 39.0 – 43.9 kg.m−2 .  The mean ( SD ) time to identify the cricothyroid membrane was 24.0 ( 12.4 ) s using the transverse technique compared with 37.6 ( 17.9 ) s for the longitudinal technique ( p = 0.0003 ) . Successful identification of the cricothyroid membrane was achieved by 38 ( 90 % ) anaesthetists using either technique . All anaesthetists were successful in identifying the cricothyroid membrane with at least one of the techniques . We advocate the learning and application of these two techniques for identification of the cricothyroid membrane before starting anaesthesia in difficult patients , especially when anatomical l and marks are impalpable . Further use in emergency situations is feasible , if clinicians have experience and the ultrasound machine is readily available Edoxaban is an oral , reversible , direct factor Xa inhibitor in phase III clinical development for the prevention of stroke in atrial fibrillation ( AF ) . A phase II study was undertaken to evaluate the safety and efficacy of edoxaban in Asian patients with non-valvular AF with CHADS2 score ≥1 . In a multicentre , active-controlled , double-blind edoxaban and open-label warfarin , parallel-group study , a total of 235 patients from four Asian countries were r and omly assigned to edoxaban 30 mg qd , 60 mg qd or warfarin dose adjusted to international normalised ratio of 2 - 3 for three months . The primary endpoint was the incidence of central ly adjudicated all bleeding events ( major , clinical ly relevant non-major and minor ) . Secondary endpoints included thromboembolic events , biomarkers of thrombus formation and all adverse events ( AEs ) . The incidence of all bleeding events ( 95 % CI ) was 20.3 % ( 12.9 , 30.4 ) for edoxaban 30 mg , 23.8 % ( 15.8 , 34.1 ) for edoxaban 60 mg , and 29.3 % ( 20.2 , 40.4 ) for warfarin . A subgroup analysis suggested low body weight ( ≤60 kg ) may affect the incidence of bleeding  events with edoxaban . The incidence of study drug-related AEs was 22 % for edoxaban 30 mg , 29 % for edoxaban 60 mg and 33 % for warfarin . No thromboembolic events occurred in any treatment group . In conclusion , this phase II study found a trend for a reduction in the incidence of all bleeding events in Asian AF patients  with edoxaban 30 mg and 60 mg compared with warfarin . Adverse events were similar between the edoxaban 60-mg and warfarin groups and were lower with the edoxaban 30-mg group BACKGROUND Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use . Dabigatran is a new oral direct thrombin inhibitor . METHODS In this noninferiority trial , we r and omly assigned 18,113 patients who had atrial fibrillation and a risk of stroke to receive , in a blinded fashion , fixed doses of dabigatran--110 mg or 150 mg twice daily -- or , in an unblinded fashion , adjusted-dose warfarin . The median duration of the follow-up period was 2.0 years . The primary outcome was stroke or systemic embolism . RESULTS Rates of the primary outcome were 1.69 % per year in the warfarin group , as compared with 1.53 % per year in the group that received 110 mg of dabigatran ( relative risk with dabigatran , 0.91 ; 95 % confidence interval [ CI ] , 0.74 to 1.11 ; P<0.001 for noninferiority ) and 1.11 % per year in the group that received 150 mg of dabigatran ( relative risk , 0.66 ; 95 % CI , 0.53 to 0.82 ; P<0.001 for superiority ) . The rate of major bleeding was 3.36 % per year in the warfarin group , as compared with 2.71 % per year in the group receiving 110 mg of dabigatran ( P=0.003 ) and 3.11 % per year in the group receiving 150 mg of dabigatran ( P=0.31 ) . The rate of hemorrhagic stroke was 0.38 % per year in the warfarin group , as compared with 0.12 % per year with 110 mg of dabigatran ( P<0.001 ) and 0.10 % per year with 150 mg of dabigatran ( P<0.001 ) . The mortality rate was 4.13 % per year in the warfarin group , as compared with 3.75 % per year with 110 mg of dabigatran ( P=0.13 ) and 3.64 % per year with 150 mg of dabigatran ( P=0.051 ) . CONCLUSIONS In patients with atrial fibrillation , dabigatran given at a dose of  
    Output:
    
Cluster rank plot incorporating stroke and major bleeding outcomes indicates that some warfarin care bundles perform as well as NOACs .
Both interventions are therefore viable options to be considered for SPAF .