The Pharmaceutical Journal
Vol 269 No 7207 p92
20 July 2002

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The Lancet (www.thelancet.com)

Aspirin plus anticoagulant better than aspirin alone after coronary events

Intensive treatment with an anticoagulant or treatment with aspirin plus an anticoagulant is more effective than aspirin alone in reducing cardiovascular events following myocardial infarction or unstable angina, say researchers from the Netherlands.

Dr Robert van Es, University Medical Centre Utrecht, and colleagues conducted a prospective open-label trial to determine whether the combination of aspirin plus a coumarin offers greater benefit than either treatment alone after acute coronary events.

They randomised 999 patients to either low-dose aspirin (equivalent to 80mg daily), a coumarin (acenocoumarol or phenprocoumon) with a target international normalised ratio (INR) of 3.0–4.0, or low-dose aspirin plus a coumarin with a target INR of 2.0–2.5.

After an average of 12 months (range 0–26 months), the researchers found that fewer patients in the coumarin and combination groups than in the aspirin alone group suffered a myocardial infarction or a stroke or died (5 per cent of patients in each of the groups treated with anticoagulants compared with 9 per cent of patients treated with aspirin alone).

"The benefits of oral anticoagulation were achieved with few adverse effects," they say. Rates of major bleeding were low in all groups, with absolute rates of 1 per cent, 1 per cent and 2 per cent per patient year for the aspirin, coumarin, and combination groups, respectively. The two-fold increase seen in patients given combination treatment was not statistically significant. However, there was a significant three-fold increase in minor bleeding for these patients (Lancet 2002;360:109).