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Review: high dose and moderate dose oral anticoagulants reduce events in coronary artery disease but increase major bleeding and are no more effective than aspirin

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 QUESTIONS: Do oral anticoagulants (OAs) reduce death, recurrent myocardial infarction (MI), and stroke and increase bleeding in patients with established coronary artery disease (CAD)? Do the effects vary with intensity of OA and aspirin use?

Data sources

Studies published between 1960 and July 1999 were identified by searching Medline, EMBASE/Excerpta Medica, and Current Contents using combinations of terms related to OAs and vascular disease; reviewing bibliographies of relevant papers; and contacting experts and pharmaceutical companies.

Study selection

Randomised trials were selected if they included patients who had established CAD, used OAs, and continued treatment for ≥3 months.

Data extraction

Data were extracted on baseline patient characteristics, intensity of OA treatment, time of initiation of treatment, duration of treatment, and number of patients discontinuing treatment.

Main results

30 reports of 31 trials were included in the analysis. Data were analysed by strata that were based …

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  • Source of funding: no external funding.

  • For correspondence: Dr S S Anand, Hamilton General Hospital, McMaster Clinic, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada. Fax +1 905 527 9642.