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  • Coumadin alone or aspirin plus coumadin reduced coronary events and death after acute myocardial infarction or unstable angina

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Therapeutics
Coumadin alone or aspirin plus coumadin reduced coronary events and death after acute myocardial infarction or unstable angina

http://dx.doi.org/10.1136/ebm.8.1.16

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    (2002) Lancet. 360, 109; van Es RF, Jonker JJ, Verheugt FW, et al, for the Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis-2 (ASPECT-2) Research Group.. Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial.. ;. :. –13.
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 QUESTION: In patients who have had acute myocardial infarction (MI) or unstable angina, is high intensity coumadin or aspirin plus moderate intensity coumadin more effective than aspirin alone for reducing coronary events and all cause mortality?

    Design

    Randomised (allocation concealed*), unblinded,* controlled trial with follow up to ≤26 months.

    Setting

    53 hospitals in the Netherlands.

    Patients

    999 patients who had had acute MI (88%) or unstable angina (13%) within the preceding 8 weeks. Exclusion criteria included planned revascularization or recent intracoronary stenting, thrombocytopenia, anaemia, and history of stroke. Follow up was 99% (mean age 61 y, 77% men).

    Intervention

    Patients were allocated to phenprocoumon or acenocoumarol with target international normalized ratio (INR) of 3.0 to 4.0 (coumadin group, n=330); aspirin, 80 mg/day, plus phenprocoumon or …

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    Footnotes

    • Sources of funding: The Netherlands National Health Insurance Fund Council and the Netherlands Heart Foundation.

    • For correspondence: Professor D Grobbee, University Medical Centre Utrecht, Utrecht, The Netherlands. d.e.grobbee{at}jc.azu.nl

    • Abstract and commentary also published in ACP Journal Club

    • ↵* See glossary.