European Heart Journal Advance Access originally published online on September 5, 2005
European Heart Journal 2006 27(5):519-526; doi:10.1093/eurheartj/ehi485
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25 307 patients
Institute of Cardiology, Catholic University, Largo F. Vito, 00168, Rome, Italy
Received 16 June 2005; revised 4 August 2005; accepted 11 August 2005; online publish-ahead-of-print 5 September 2005.
* Corresponding author. Tel: +39 0 6 30154187; fax: +39 0 6 3055535. E-mail address: felicita.andreotti{at}iol.it
Aims In patients recovering from acute coronary syndromes (ACS) the role of oral anticoagulation (and its intensity) in addition to aspirin remains controversial. We conducted a specific meta-analysis of randomized trials comparing aspirin plus warfarin (A+W) with aspirin alone in such patients.
Methods and results MEDLINE and Cochrane databases yielded 14 (of 148 potentially relevant) articles enrolling 25 307 patients. Follow-up ranged from 3 months to 5 years. Irrespective of International normalized ratio (INR), A+W did not significantly affect the risk of major adverse events (MAE: all cause death, non-fatal myocardial infarction, and non-fatal thrombo-embolic stroke) when compared with aspirin alone [OR 0.96 (0.901.03), P=0.30], but increased the risk of major bleeds (MB): OR 1.77 (1.472.13), P<0.00001. However, in studies with INR of 23, A+W was associated with a significant reduction of MAE [OR 0.73 (0.630.84), P<0.0001, number needed to treat to avoid one MAE=33], albeit at an increased risk of MB [OR 2.32 (1.633.29), P<0.00001; number needed to harm by causing one MB=100]. In both analyses, intracranial bleeding was not significantly increased by A+W when compared with aspirin alone.
Conclusion For patients recovering from ACS, a combined strategy of A+W at INR values of 23 doubles the risk of MB, but is nonetheless superior to aspirin alone in preventing MAE. Whether this combined regimen is also superior to a double anti-platelet strategy or to newer evolving treatments warrants further investigation.
Key Words: Aspirin Warfarin Acute coronary syndromes Meta-analysis Outcome Risk/benefit ratio
![]()
CiteULike
Connotea
Del.icio.us What's this?
This article has been cited by other articles:
![]() |
J. Ansell, J. Hirsh, E. Hylek, A. Jacobson, M. Crowther, and G. Palareti Pharmacology and Management of the Vitamin K Antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 160S - 198S. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Schulman, R. J. Beyth, C. Kearon, and M. N. Levine Hemorrhagic Complications of Anticoagulant and Thrombolytic Treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 257S - 298S. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. Y H Lip Don't add aspirin for associated stable vascular disease in a patient with atrial fibrillation receiving anticoagulation BMJ, March 15, 2008; 336(7644): 614 - 615. [Full Text] [PDF] |
||||
![]() |
The Warfarin Antiplatelet Vascular Evaluation Tria Oral Anticoagulant and Antiplatelet Therapy and Peripheral Arterial Disease N. Engl. J. Med., July 19, 2007; 357(3): 217 - 227. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. C. Nguyen, Y. L. Lim, A. Walton, J. Lefkovits, G. Agnelli, S. G. Goodman, A. Budaj, D. C. Gulba, J. Allegrone, D. Brieger, et al. Combining warfarin and antiplatelet therapy after coronary stenting in the Global Registry of Acute Coronary Events: is it safe and effective to use just one antiplatelet agent? Eur. Heart J., July 2, 2007; 28(14): 1717 - 1722. [Abstract] [Full Text] [PDF] |
||||
![]() |
Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660. [Full Text] [PDF] |
||||
![]() |
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] |
||||
![]() |
G. Y. H. Lip and M. Karpha Anticoagulant and Antiplatelet Therapy Use in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: The Need for Consensus and a Management Guideline Chest, December 1, 2006; 130(6): 1823 - 1827. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. G.L. Biondi-Zoccai, M. Lotrionte, P. Agostoni, A. Abbate, M. Fusaro, F. Burzotta, L. Testa, I. Sheiban, and G. Sangiorgi A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease Eur. Heart J., November 2, 2006; 27(22): 2667 - 2674. [Abstract] [Full Text] [PDF] |
||||



