title: A placebo-controlled randomized trial of warfarin in idiopathic pulmonary fibrosis.
abstract: BACKGROUND
  Animal and human studies support the importance of the coagulation cascade in pulmonary fibrosis.
  
  
  OBJECTIVE
  In a cohort of subjects with progressive idiopathic pulmonary fibrosis (IPF), we tested the hypothesis that treatment with warfarin at recognized therapeutic doses would reduce rates of mortality, hospitalization, and declines in FVC.
  
  
  METHODS
  This was a double-blind, randomized, placebo-controlled trial of warfarin targeting an international normalized ratio of 2.0 to 3.0 in patients with IPF. Subjects were randomized in a 1:1 ratio to warfarin or matching placebo for a planned treatment period of 48 weeks. International normalized ratios were monitored using encrypted home point-of-care devices that allowed blinding of study therapy.
  
  
  RESULTS
  The primary outcome measure was the composite outcome of time to death, hospitalization (nonbleeding, nonelective), or a 10% or greater absolute decline in FVC. Due to a low probability of benefit and an increase in mortality observed in the subjects randomized to warfarin (14 warfarin versus 3 placebo deaths; P = 0.005) an independent Data and Safety Monitoring Board recommended stopping the study after 145 of the planned 256 subjects were enrolled (72 warfarin, 73 placebo). The mean follow-up was 28 weeks.
  
  
  CONCLUSIONS
  This study did not show a benefit for warfarin in the treatment of patients with progressive IPF. Treatment with warfarin was associated with an increased risk of mortality in an IPF population who lacked other indications for anticoagulation.
authors.affiliation: University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637-6076, USA. inoth@medicine.bsd.uchicago.edu
authors.forename: Imre
authors.initials: I
authors.lastname: Noth
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Sara Bristol
authors.initials: SB
authors.lastname: Calvert
authors.forename: Joao
authors.initials: J
authors.lastname: de Andrade
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Flaherty
authors.forename: Craig
authors.initials: C
authors.lastname: Glazer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Kaner
authors.forename: Mitchell A
authors.initials: MA
authors.lastname: Olman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin