Copyright © 2004 by the European Society of Cardiology.
Clinical research
Effect of fixed low-dose warfarin added to aspirin in the long term after acute myocardial infarction
the LoWASA Study
a Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
b Department of Cardiology, Malmö University Hospital, Malmö, Sweden
c Medical Department, Lidköping Hospital, Lidköping, Sweden
* Corresponding author: Johan Herlitz, Assoc. Prof., Division of Cardiology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. Tel.: +46-31-342-1000; Fax: 46-31-829650
E-mail address: johan.herlitz{at}hjl.gu.se
Received 16 April 2003; revised 24 September 2003; accepted 23 October 2003
Abstract
Aim To evaluate whether long-term treatment with a fixed low dose of warfarin in combination with aspirin improves the prognosis compared with aspirin treatment alone after an acute myocardial infarction (AMI).
Methods Patients who were hospitalized for AMI were randomized to either 1.25mg of warfarin plus 75mg of aspirin (n=1659) daily or 75mg of aspirin alone (n=1641). The study was performed according to the PROBE (Prospective Open Treatment and Blinded End Point Evaluation) design and was conducted at 31 hospitals in Sweden. The median follow-up time was 5.0 years. In the aspirin+warfarin group, 30.2% were permanently withdrawn as opposed to 14.0% in the aspirin group (P<0.0001). Analyses were performed on an intention-to-treat basis.
Results The combination of cardiovascular death, reinfarction or stroke was registered in 28.1% in the aspirin+warfarin group versus 28.8% in the aspirin group (NS). Cardiovascular deaths occurred in 14.2% in the aspirin+warfarin group vs 15.7% in the aspirin group (NS). Whereas no difference was found with regard to total mortality or reinfarction, those randomized to aspirin+warfarin had a reduced occurrence of stroke (4.7% vs 7.1%; P=0.004). The percentage of patients who suffered a serious bleed was 1.0% in the aspirin group vs 2.2% in the combination group (P=0.0006).
Conclusion A fixed low dose of warfarin added to aspirin in the long term after AMI did not reduce the combined risk of cardiovascular death, reinfarction or stroke. The results did, however, indicate that a fixed low dose of warfarin added to aspirin reduced the risk of stroke, but this was a secondary end point. The combination of aspirin and warfarin was associated with an increased risk of bleeding.
Key Words: Acute myocardialinfarction • Prognosis • Warfarin
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  R. De Caterina, S. Husted, L. Wallentin, G. Agnelli, F. Bachmann, C. Baigent, J. Jespersen, S. D. Kristensen, G. Montalescot, A. Siegbahn, et al. Anticoagulants in heart disease: current status and perspectives Eur. Heart J., April 10, 2007; (2007) ehl492v1. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Madjid, J. T. Willerson, and S. W. Casscells Intracoronary Thermography for Detection of High-Risk Vulnerable Plaques. J. Am. Coll. Cardiol., April 18, 2006; 47(8S): C80 - C85. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.E. Husted, B.K. Ziegler, and A. Kher Long-term anticoagulant therapy in patients with coronary artery disease Eur. Heart J., April 2, 2006; 27(8): 913 - 919. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Andreotti, L. Testa, G. G.L. Biondi-Zoccai, and F. Crea Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25 307 patients Eur. Heart J., March 1, 2006; 27(5): 519 - 526. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Calo, L. Bianconi, F. Colivicchi, F. Lamberti, M. L. Loricchio, E. de Ruvo, A. Meo, C. Pandozi, M. Staibano, and M. Santini N-3 Fatty Acids for the Prevention of Atrial Fibrillation After Coronary Artery Bypass Surgery: A Randomized, Controlled Trial J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1723 - 1728. [Abstract] [Full Text] [PDF]
|
|