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

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

https://doi.org/10.1136/ebm.11.2.43

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    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.
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 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 ★★★★★★☆ Cardiology ★★★★★☆☆ Haematology ★★★★★★☆

    METHODS

    Embedded ImageData sources:

    Medline (January 1990 to October 2004) and researchers in the field.

    Embedded ImageStudy selection and assessment:

    randomised controlled trials (RCTs) (published in English) that compared aspirin plus warfarin with aspirin alone in patients with an ACS. Studies of percutaneous coronary intervention or low intensity warfarin (target international normalised ratio <2.0) were excluded. Study quality was assessed using criteria that included proper randomisation, allocation concealment, and completeness of follow up.

    Embedded ImageOutcomes:

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

    MAIN RESULTS

    10 RCTs (n = 5938) met the selection criteria. …

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    Footnotes

    • For correspondence: Dr M B Rothberg, Baystate Medical Center, Springfield, MA, USA. Michael.Rothberg{at}bhs.org

    • Source of funding: not stated.