Coronary disease: Long-term Antithrombotic treatment: Combining aspirin with oral anticoagulants (warfarin)
DISEASE INTERVENTION COMPARISON RESULTS
JAMA. 1999 Dec 1;282(21):2058-67 Meta-Analysis
IN coronary disease The Use of
vitamin K antagonists, added to aspirin, but not alone
As Treatment, Chronic
Is better Than
aspirin alone
To prevent myocardial infarction or stroke (risk reduction not given), but based in few studies (3 studies, 480 patients) and increasing bleeding risk by about 2 fold.
Ann Intern Med. 2005 Aug 16;143(4):241-50 Meta-Analysis
IN coronary disease, acute coronary syndrome, myocardial infarction The Use of
vitamin K antagonists, warfarin, added to aspirin
As Treatment, Chronic
Is better Than
aspirin alone, NOT compared to aspirin plus clopidrogel
To decrease the annual rate of myocardial infarction (0.022 vs. 0.041) and ischemic stroke (0.004 vs. 0.008) but not to reduce mortality. Major bleeding increased (0.015 vs. 0.006)
N Engl J Med. 2002 Sep 26;347(13):969-74 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction The Use of
vitamin K antagonists, warfarin, added to aspirin or alone
As Treatment, Chronic
Is better Than
aspirin alone
To reduce cardiovascular events (death, MI or ischemic stroke), rates per year: 3.5% warfarin plus aspirin VS 4.2% warfarin VS 5% aspirin.
Arch Intern Med. 2007 Jan 22;167(2):117-24 Meta-Analysis
IN heart valve disease, mechanical heart valve, atrial fibrillation, coronary disease The Use of
aspirin, added to vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
vitamin K antagonists, warfarin, alone
To reduce arterial thromboembolism, but only in patients with mechanical heart valve (OR 0.27) and not for coronary disease or atrial fibrillation. There was not differences in all-cause mortality and major bleeding was higher (OR 1.43)