Key result
Warfarin combined with low-dose aspirin did not provide clinical benefit beyond aspirin alone for all-cause mortality in survivors of acute myocardial infarction.
Why the study?
Does warfarin combined with aspirin reduce all-cause mortality in patients who have survived an acute myocardial infarction compared to aspirin alone?
RCT (n=5,059)
Unblinded
allocation concealed
Yes
Does warfarin combined with aspirin reduce all-cause mortality in patients who have survived an acute myocardial infarction compared to aspirin alone?
Adding warfarin to low-dose aspirin does not provide additional clinical benefit over aspirin alone in survivors of acute myocardial infarction.
Answers are grounded in this paper and cite their sources.
Reinforces aspirin monotherapy post-MI; confirms no mortality benefit from adding warfarin and challenges combination regimens.
(2002) Circulation 105, 557; Fiore LD, Ezekowitz MD, Brophy MT, et al., for the Combination Hemotherapy and Mortality Prevention (CHAMP) Study Group. . Department of Veterans Affairs Cooperative Studies Program Clinical Trial comparing combined warfarin and aspirin with aspirin alone in survivors of acute myocardial infarction. Primary results of the CHAMP study. . Feb 5; . : . –63. . [OpenUrl][1][Abstract/FREE Full Text][2] QUESTION: In patients who have survived an acute myocardial infarction (MI), is warfarin combined with aspirin more effective than aspirin alone? Randomised (allocation concealed*), unblinded,* controlled trial with a median 2.7 years of follow up. 78 Department of Veterans Affairs medical centres in the US. 5059 patients (median age 62 y, 98% men) who had an acute MI within the previous 14 days. Exclusion criteria included comorbid conditions that limited life expectancy to <2 years, ongoing bleeding, drug or alcohol dependence, and hypersensitivity to aspirin or warfarin. Vital status was obtained for 99% of the patients. 2522 patients were assigned to warfarin (target international normalised ratio [INR] 1.5 to 2.5 IU) plus aspirin (81 mg/d), and 2537 were assigned to aspirin alone (162 mg/d). The primary outcome was all-cause mortality. Secondary outcomes were recurrent MI, stroke, … [1]: {openurl}?query=rft.jtitle%253DCirculation%26rft.stitle%253DCirculation%26rft.issn%253D0009-7322%26rft.aulast%253DFiore%26rft.auinit1%253DL.%2BD.%26rft.volume%253D105%26rft.issue%253D5%26rft.spage%253D557%26rft.epage%253D563%26rft.atitle%253DDepartment%2Bof%2BVeterans%2BAffairs%2BCooperative%2BStudies%2BProgram%2BClinical%2BTrial%2BComparing%2BCombined%2BWarfarin%2Band%2BAspirin%2BWith%2BAspirin%2BAlone%2Bin%2BSurvivors%2Bof%2BAcute%2BMyocardial%2BInfarction%253A%2BPrimary%2BResults%2Bof%2Bthe%2BCHAMP%2BStudy%26rft_id%253Dinfo%253Adoi%252F10.1161%252Fhc0502.103329%26rft_id%253Dinfo%253Apmid%252F11827919%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=circulationaha&resid=105/5/557&atom=%2Febmed%2F7%2F5%2F140.atom
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V M Oh (2002) conducted an RCT in acute myocardial infarction (n=5,059). Warfarin plus aspirin vs. Aspirin alone 162 mg/d was evaluated on all-cause mortality. Warfarin combined with low-dose aspirin did not provide clinical benefit beyond aspirin alone for all-cause mortality in survivors of acute myocardial infarction.
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