Key result
Warfarin reduced morbidity and mortality compared to aspirin when dosed as monotherapy to INRs 3.0-4.0 or combined with aspirin 75- daily to INRs 2.0-2.5 in post-MI patients.
Why the study?
Does warfarin reduce morbidity and mortality compared to aspirin in post-myocardial infarction patients?
Does warfarin reduce morbidity and mortality compared to aspirin in post-myocardial infarction patients?
In post-MI patients, warfarin provides clinical benefit over aspirin only when dosed adequately as monotherapy (INR 3.0-4.0) or in combination with low-dose aspirin (INR 2.0-2.5).
Answers are grounded in this paper and cite their sources.
Supports targeted warfarin post-MI at specified INRs; leaves open validation versus modern regimens.
This article reviews recent trials that have compared aspirin to anticoagulation in post-myocardial infarction (MI) patients. Warfarin dosed to international normalized ratios (INRs) between 2.8 and 4.2 was superior to placebo in reducing morbidity and mortality; however, post-MI patients are generally receiving aspirin. When aspirin therapy was compared to warfarin plus aspirin, no clinical benefit occurred when warfarin was dosed to achieve INRs less than 2.0. In contrast, warfarin reduced morbidity and mortality compared to aspirin when it was dosed as monotherapy to achieve INRs between 3.0 and 4.0 or used with aspirin 75 to 80 mg daily and dosed to INRs between 2.0 and 2.5. With respect to mortality alone, warfarin was superior to aspirin only when it was used as monotherapy and compared to aspirin 80 mg daily. No difference in mortality was observed when warfarin monotherapy was compared to aspirin 160 mg daily.
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Earl et al. (2004) conducted a review in post-myocardial infarction. Warfarin vs. Aspirin or placebo was evaluated on Morbidity and mortality. Warfarin reduced morbidity and mortality compared to aspirin when dosed as monotherapy to INRs 3.0-4.0 or combined with aspirin 75- daily to INRs 2.0-2.5 in post-MI patients.
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