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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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 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?


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


53 hospitals in the Netherlands.


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).


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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