Review: aspirin plus warfarin decreases cardiovascular morbidity with an increase in major bleeding in acute coronary syndromes

doi:10.1136/ebm.11.2.43

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Evidence-Based Medicine 2006;11:43; doi:10.1136/ebm.11.2.43
Copyright © 2006 by the BMJ Publishing Group Ltd.

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Therapeutics

Review: aspirin plus warfarin decreases cardiovascular morbidity with an increase in major bleeding in acute coronary syndromes

Rothberg MB, Celestin C, Fiore LD, et al. Warfarin plus aspirin after myocardial infarction or the acute coronary syndrome: meta-analysis with estimates of risk and benefit. Ann Intern Med 2005;143:241–50.[Abstract/Free Full Text]

Q In patients who have had an acute coronary syndrome (ACS), what are the benefits and risks of treatment with aspirin plus warfarin compared with aspirin alone?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ $*$ $*$ IM/Ambulatory care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Cardiology $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Haematology $*$ $*$ $*$ $*$ $*$ $*$ ${star}$

Key Words: aspirin • acute coronary syndromes • unstable angina • myocardial infarction • warfarin

The first 150 words of the full text of this article appear below.

METHODS
Data sources: Medline (January 1990 to October 2004) and researchers in thefield.

Study selection and assessment: randomised controlled trials (RCTs) (published in English) thatcompared aspirin plus warfarin with aspirin alone in patientswith an ACS. Studies of percutaneous coronary intervention orlow intensity warfarin (target international normalised ratio<2.0) were excluded. Study quality was assessed using criteriathat included proper randomisation, allocation concealment,and completeness of follow up.

Outcomes: myocardial infarction, ischaemic stroke, revascularisation,all cause mortality, and major and minor bleeding.

MAIN RESULTS
10 RCTs (n = 5938) met the selection criteria. Aspirin dosevaried from 80–325 mg daily. Target international normalisedratio for most studies was 2.0–2.5. Meta-analysis wasdone using a random effects model. The rates of myocardial infarction,ischaemic stroke, and revascularisation were lower in the combinationgroup than in the aspirin alone group (table). However, therates of major and minor bleeding were greater . . . [Full text of this article]

Richard G Bach, MD

Barnes-Jewish Hospital/Washington University, St. Louis, Missouri, USA