Why the study?
Does combined aspirin and warfarin improve secondary prevention of death and ischemic events compared to aspirin alone in post-MI patients?
Does combined aspirin and warfarin improve secondary prevention of death and ischemic events compared to aspirin alone in post-MI patients?
Dual therapy with aspirin and warfarin may offer additional benefit over aspirin alone for secondary prevention in high-risk post-MI patients.
Answers are grounded in this paper and cite their sources.
May support dual therapy in select high-risk post-MI patients; leaves open need for RCTs versus aspirin alone.
OBJECTIVE: To review data concerning combined aspirin/warfarin versus aspirin alone for secondary prevention after myocardial infarction (MI). DATA SOURCES: Literature was accessed through MEDLINE (1966-September 2002). Search terms included aspirin, warfarin, secondary prevention, and myocardial infarction. DATA SYNTHESIS: Despite use of low-dose aspirin after an MI, risk of subsequent death and ischemic events remains high, making strategies for secondary prevention imperative. Relevant, large, long-term studies focusing on dual aspirin/warfarin versus aspirin alone in post-MI patients were evaluated. CONCLUSIONS: Aspirin 75-325 mg/d should remain first-line therapy for secondary prevention after MI. Combining aspirin 75-81 mg with warfarin to maintain the international normalized ratio at 2.0-2.5 may provide added benefit, but should be considered only for patients at high risk for thromboembolic events.
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Jeddy et al. (2003) studied this question.
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