***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: In this paper are reported the basal results of a multidisciplinary , multicenter study design ed to explore in a population with ischemic disease the relation between hemostatic variables , conventional risk factors and atherothrombotic sequelae . 953 patients less than or equal to 69 yrs with documented coronary , cerebral or peripheral atherosclerotic disease were studied and followed-up for 24 months . Examinations included  hemostatic and lipid laboratory assays , arterial Doppler examination , cerebral computerized tomography and nuclear magnetic resonance , exercise electrocardiogram and coronary angiography . Fibrinogen ( 301.4 + /- 71.52 mg/dl ) correlated positively with antithrombin III ( r = 0.27 ) and leukocytes ( r = 0.25 ) , negatively with HDL-cholesterol ( r = 0.18 ) and tended to increase with smoking . Heavy smokers had higher leukocyte counts than non-smokers ( 8.0 + /- 2.0 vs. 7.2 + /- 2.1 x 10(3)/microliters ) , higher triglycerides ( 1.87 + /- 1.12 vs. 1.53 + /- 1.35 mmol/l ) and lower HDL-cholesterol ( 0.93 + /- 0.27 vs. 1.00 + /- 0.25 mmol/l ) . FVII correlated positively with triglycerides ( r = 0.16 ) and protein C ( r = 0.45 ) . vWF : Ag ( 145.4 + /- 70.58 % ) ad FVII : C ( 139.7 + /- 59.10 % ) were positively correlated ( r = 0.44 ) . FVIII : C correlated positively with fibrinogen ( r = 0.21 ) . Myocardial infa rct ion survivors with associated cerebral and peripheral vascular lesions had higher FVIII : C , FVII , fibronogen and vWF : Ag . These findings suggest that hemostatic factors may enhance and /or mediate the effects of conventional risk factors in atherothrombotic ischemic events BACKGROUND AND METHODS The use of oral anticoagulation in the long-term treatment of survivors of acute myocardial infa rct ion has been highly controversial . We therefore r and omly assigned 1214 patients who had recovered from acute myocardial infa rct ion ( mean interval from the onset of symptoms to r and omization , 27 days ) to treatment with warfarin ( 607 patients ) or placebo ( 607 patients ) for an average of 37 months ( range , 24 to 63 ) . RESULTS At the end of the treatment period , there had been 123 deaths in the placebo group and 94 in the warfarin group -- a reduction in risk of 24 percent ( 95 percent confidence interval , 4 to 44 percent ; P = 0.027 ) . A total of 124 patients in the placebo group had reinfa rct ions , as compared with 82 in the warfarin group -- a reduction of 34 percent ( 95 percent confidence interval , 19 to 54 percent ; P = 0.0007 ) . Furthermore , we observed a reduction of 55 percent ( 95 percent confidence interval , 30 to 77 percent ) in the number of total cerebrovascular accidents in the warfarin group as compared with the placebo group ( 44 vs. 20 ; P = 0.0015 ) . Serious bleeding was noted in 0.6 percent of the warfarin-treated patients per year . CONCLUSIONS Long-term therapy with warfarin has an important beneficial effect after myocardial infa rct ion and can be recommended in the treatment of patients who survive the acute phase Background —Reinfa rct ion after primary percutaneous coronary intervention in patients with ST-segment – elevation myocardial infa rct ion has negative consequences . Little is known about reinfa rct ion after drug-eluting stents and bivalirudin anticoagulation . We , therefore , sought to determine the incidence , predictors , and implication s of reinfa rct ion after primary percutaneous coronary intervention in the contemporary era . Methods and Results — Outcomes were assessed in 3202 patients undergoing stent implantation for ST-segment – elevation myocardial infa rct ion in the Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infa rct ion ( HORIZONS-AMI ) trial . Independent predictors of reinfa rct ion and mortality were identified by Cox proportional hazards modeling . The cumulative incidence of reinfa rct ion was 1.8 % at 30 days , 4.0 % at 1 year , and 6.9 % at 3 years . Definite stent thrombosis was responsible for 76.3 % of reinfa rct ions occurring within 30 days and 52.0 % of all reinfa rct ions within 3 years . Independent predictors of reinfa rct ion were current smoking , Killip class ≥2 , baseline thrombocytosis , multivessel disease , symptom onset-to-balloon time , and total stent length . R and omization to bivalirudin versus heparin plus a glycoprotein IIb/IIIa inhibitor and use of drug-eluting versus bare metal stents were not significant predictors of reinfa rct ion . Reinfa rct ion was a powerful independent predictor of subsequent cardiac mortality ( hazard ratio [ 95 % confidence interval]=7.65 [ 4.47–13.09 ] ; P<0.0001 ) and all-cause mortality ( hazard ratio [ 95 % confidence interval]=2.88 [ 1.74–4.78 ] ; P<0.0001 ) . Conclusions —Despite advances in pharmacotherapy and stents , reinfa rct ion after primary percutaneous coronary intervention is not infrequent , in the contemporary era is most often attributable to stent thrombosis , and is strongly associated with subsequent cardiac and all-cause mortality . Further enhancements in drugs and devices to prevent reinfa rct ion are needed to improve outcomes in high-risk patients with ST-segment – elevation myocardial infa rct ion . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00433966 OBJECTIVES --To assess the incidence and significance of anticardiolipin antibodies after myocardial infa rct ion and in unstable angina . DESIGN --A prospect i ve study of all patients under 60 admitted to the coronary care unit over a 12 month period with a diagnosis of acute myocardial infa rct ion who were followed up for a further 12 months . Patients admitted with unstable angina were similarly assessed but not followed up . Anticardiolipin antibody concentrations were compared with those of age matched controls . SETTING --A district general hospital . PATIENTS --307 patients with acute myocardial infa rct ion and 160 patients with unstable angina . RESULTS --Anticardiolipin antibody concentrations in the two patient groups did not differ significantly from those in the control groups . Antibody concentrations were not related to a history of angina or myocardial infa rct ion nor were they related to subsequent cardiovascular complications . CONCLUSION --This study shows no significant association between anticardiolipin antibody concentrations and either myocardial infa rct ion or unstable angina Antiphospholipid antibodies have been suggested as markers for a high risk of recurrent cardiovascular events in young survivors of an acute myocardial infa rct ion . However , there are few data to confirm or refute this hypothesis . In a cohort study , we have measured  anticephalin ( aCEPHA ) and anticardiolipin ( aCL ) antibodies  in a group of patients surviving an acute infa rct . Of 597 patients studied , 13.2 % were IgG or IgM aCEPHA positive compared with 4.4 % of a reference population ( n = 158 ; p = 0.002 ) . In a multivariate analysis , adjusted for major cardiovascular risk factors , neither aCEPHA ( IgG or IgM ) nor a CL ( IgG or IgM ) was an independent risk factor for mortality , reinfa rct ion , or non-haemorrhagic stroke . Although an increased proportion of survivors of a myocardial infa rct ion have antiphospholipid antibodies , the presence of such antibodies is not a risk factor for subsequent coronary or cerebrovascular thrombosis BACKGROUND Acute coronary syndromes arise from coronary atherosclerosis with superimposed thrombosis . Since factor Xa plays a central role in thrombosis , the inhibition of factor Xa with low-dose rivaroxaban might improve cardiovascular outcomes in patients with a recent acute coronary syndrome . METHODS In this double-blind , placebo-controlled trial , we r and omly assigned 15,526 patients with a recent acute coronary syndrome to receive twice-daily doses of either 2.5 mg or 5 mg of rivaroxaban or placebo for a mean of 13 months and up to 31 months . The primary efficacy end point was a composite of death from cardiovascular causes , myocardial infa rct ion , or stroke . RESULTS Rivaroxaban significantly reduced the primary efficacy end point , as compared with placebo , with respective rates of 8.9 % and 10.7 % ( hazard ratio in the rivaroxaban group , 0.84 ; 95 % confidence interval [ CI ] , 0.74 to 0.96 ; P=0.008 ) , with significant improvement for both the twice-daily 2.5-mg dose ( 9.1 % vs. 10.7 % , P=0.02 ) and the twice-daily 5-mg dose ( 8.8 % vs. 10.7 % , P=0.03 ) . The twice-daily 2.5-mg dose of rivaroxaban reduced the rates of death from cardiovascular causes ( 2.7 % vs. 4.1 % , P=0.002 ) and from any cause ( 2.9 % vs. 4.5 % , P=0.002 ) , a survival benefit that was not seen with the twice-daily 5-mg dose . As compared with placebo , rivaroxaban increased the rates of major bleeding not related to coronary-artery bypass grafting ( 2.1 % vs. 0.6 % , P<0.001 ) and intracranial hemorrhage ( 0.6 % vs. 0.2 % , P=0.009 ) , without a significant increase in fatal bleeding ( 0.3 % vs. 0.2 % , P=0.66 ) or other adverse events . The twice-daily 2.5-mg dose result ed in fewer fatal bleeding events than the twice-daily 5-mg dose ( 0.1 % vs. 0.4 % , P=0.04 ) . CONCLUSIONS In patients with a recent acute coronary syndrome , rivaroxaban reduced the risk of the composite end point of death from cardiovascular causes , myocardial infa rct ion , or stroke . Rivaroxaban increased the risk of major bleeding and intracranial hemorrhage but not the risk of fatal bleeding . ( Funded by Johnson & Johnson and Bayer Healthcare ; ATLAS ACS 2-TIMI 51 Clinical Trials.gov number , NCT00809965 . ) CONTEXT The presence of antiphospholipid antibodies ( aPL ) has been associated with vascular occlusive events . However , the role of aPL in predicting ischemic events , particularly recurrent ischemic stroke , is controversial . OBJECTIVE To evaluate the effect of baseline aPL positivity ( ie , positivity for anticardiolipin antibodies [ aCL ] , lupus anticoagulant antibodies [ LA ] , or both ) on subsequent thrombo-occlusive events , including recurrent stroke . DESIGN , SETTING , AND PARTICIPANTS The Antiphospholipid Antibodies and Stroke Study ( APASS ) , a prospect i ve cohort study within the Warfarin vs Aspirin Recurrent Stroke Study ( WARSS ) , a r and omized double-blind trial ( N = 2206 ) conducted at multiple US clinical sites from June 1993 through June 2000 and comparing adjusted-dose warfarin ( target international normalized ratio , 1.4 - 2.8 ) and aspirin ( 325 mg/d ) for prevention of recurrent stroke or death . APASS participants were 1770 ( 80 % ) WARSS participants who consented to enroll in the APASS , with usable baseline blood sample s drawn prior to r and omization to the WARSS and analyzed for aPL status within 90 days of index stroke by a central independent laboratory . Quality assurance was performed on approximately 10 % of sample s by a second independent laboratory . MAIN OUTCOME MEASURE Two-year rate of the composite end point of death from any cause , ischemic stroke , transient ischemic attack , myocardial infa rct ion , deep vein thrombosis , pulmonary embolism , and other systemic thrombo-occlusive events . The primary analysis assessed the outcome associated with aPL positivity within each WARSS treatment group separately , after risk-factor adjustment ( since these aPL 
    Output:
    
CONCLUSION Patients with CAD and elevated IgG aCL have a doubled risk of recurrent MACE at 12 and 24 months .