The Pharmaceutical Journal
Vol 268 No 7185 p197-203
16 February 2002

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Aspirin and warfarin no better than aspirin alone

There is no reduction in mortality, stroke, or recurrent myocardial infarction in patients treated with a combination of aspirin and warfarin compared with those treated with aspirin alone, say researchers.

Dr Louis Flore, Veteran Affairs Boston Healthcare System, Massachusetts, and colleagues conducted an open-label trial to determine whether a combination of aspirin and warfarin would be more effective than aspirin monotherapy for secondary prevention of vascular events and death after acute myocardial infarction (AMI). The trial involved 5,059 patients, of whom 2,537 received 162mg aspirin daily and 2,522 received warfarin (target INR 1.5–2.5IU) plus 81mg aspirin daily. All patients had suffered an AMI within the previous 14 days and were followed up for a median of 2.7 years.

The researchers found that 17.3 per cent of patients in the aspirin group and 17.6 per cent of patients in the combination group died. Recurrent MI or stroke occurred in 13.1 and 3.5 per cent of patients in the aspirin group compared with 13.3 and 3.1 per cent of patients in the combination therapy group.

Although the annual incidence of major bleeding episodes (mainly gastrointestinal) was low, levels in the combination group were higher than those in the aspirin group (P<0.001), say the researchers. The incidence of intracranial haemorrhage was equal in both groups, with fatal haemorrhage occurring in seven patients from the aspirin group and 10 patients from the combination group.

The authors conclude that in post myocardial infarction patients, warfarin therapy combined with low dose aspirin does not provide a clinical benefit beyond that achievable by aspirin alone (Circulation 2002;105:557).