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Abstract

Spanish

French

Objective

To review data concerning combined aspirin/warfarin versus aspirin alone for secondary prevention after myocardial infarction (MI).

Data Sources

Literature was accessed through MEDLINE (1966–September 2002). Search terms included aspirin, warfarin, secondary prevention, and myocardial infarction.

Data Synthesis

Despite use of low-dose aspirin after an MI, risk of subsequent death and ischemic events remains high, making strategies for secondary prevention imperative. Relevant, large, long-term studies focusing on dual aspirin/warfarin versus aspirin alone in post-MI patients were evaluated.

Conclusions

Aspirin 75–325 mg/d should remain first-line therapy for secondary prevention after MI. Combining aspirin 75–81 mg with warfarin to maintain the international normalized ratio at 2.0–2.5 may provide added benefit, but should be considered only for patients at high risk for thromboembolic events.

Keywords

aspirin combination therapy myocardial infarction secondary prevention warfarin

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References

2002 Heart and stroke statistical update. Dallas, TX: American Heart Association, 2001.

Shah

Pathophysiology of coronary thrombosis: role of plaque rupture and plaque erosion. Prog Cardiovasc Dis 2002;44:357–68.

Bahit

Granger

Wallentin

Persistence of the prothrombotic state after coronary syndromes: implications for treatment. Am Heart J 2002;143:205–16.

Stringer

Lopez

Uncomplicated myocardial infarction. In: Dipiro

Talbert

Yee

Matzke

Wells

Posey

Pharmacotherapy - a pathophysiologic approach. 5th ed. New York: McGraw-Hill, 2002:251–7.

Becker

Antithrombotic therapy after myocardial infarction. N Engl J Med 2002;347:1019–21.

Antiplatelet Trialists' Collaboration. Collaborative overview of randomized trials of antiplatelet therapy. I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994;308:81–106.

Smith

Arnesen

Holme

The effect of warfarin on mortality and reinfarction after myocardial infarction. N Engl J Med 1990;323:147–52.

Meijer

Verheugt

FWA

Werter

Lie

van der Pol

van Eenige

Aspirin versus Coumadin in the prevention of reocclusion and recurrent ischemia after successful thrombolysis: a prospective placebo-controlled angiographic study. Results of the APRICOT study. Circulation 1993;87:1524–30.

ASPECT Research Group. Effect of long-term oral anticoagulant treatment on mortality and cardiovascular mortality after myocardial infarction: Anticoagulants in the Secondary Prevention of Events In Coronary Thrombosis (ASPECT) Research Group. Lancet 1994;90:499–533.

10.

Huynh

Theroux

Bogaty

Nasmith

Solymoss

Aspirin, warfarin, or the combination for secondary prevention of coronary events in patients with acute coronary syndromes and prior coronary artery bypass surgery. Circulation 2001;103:3069–74.

11.

Ryan

Antman

Brooks

Califf

Hillis

Hiratzka

1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). www.acc.org (accessed 2002 Nov 11).

12.

Coumadin Aspirin Reinfarction Study (CARS) Investigators. Randomised double-blind trial of fixed low-dose warfarin with aspirin after myocardial infarction. Lancet 1997;350:389–96.

13.

Fiore

Ezekowitz

Brophy

Sacco

Peduzzi

Department of Veterans Affairs cooperative studies program clinical trial comparing combined warfarin and aspirin with aspirin alone in survivors of acute myocardial infarction: primary results from the CHAMP study. Circulation 2002;105:557–63.

14.

van Es

Jonker

Verheugt

FWA

Deckers

Grobbee

Aspirin and Coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial. Lancet 2002;360:109–13.

15.

Hurlen

Abdelnoor