Acute Coronary Syndrome Patient Treatment
Friday, June 1, 2007
PTINR.com Staff
Aspirin and warfarin found to be superior than aspirin alone but contributed to increased bleeding risk.
Patients recovering from acute coronary syndromes (ACS) may receive aspirin, warfarin or a combination of both. A meta-analysis of 25,307 patients from MEDLINE and Cochrane databases evaluated the efficacy of aspirin plus warfarin (Coumadin ®) to aspirin alone.
Major adverse events (MAE) included: all causes of death, non-fatal myocardial infarction and non-fatal thrombo-embolic stroke. Combination therapy (warfarin + aspirin) did not significantly increase the rate of major adverse events when compared to aspirin alone. [OR 0.96 (0.90–1.03), P=0.30], but increased the risk of major bleeds (MB): OR 1.77 (1.47–2.13), P<0.00001. However, in studies with INR of 2–3, A+W was associated with a significant reduction of MAE [OR 0.73 (0.63–0.84), P<0.0001, number needed to treat to avoid one MAE=33], albeit at an increased risk of MB [OR 2.32 (1.63–3.29), P<0.00001; number needed to harm by causing one MB=100]. European Heart Journal, Vol.27, p.519-526.
The authors concluded the combination of aspirin and warfarin at a target range of 2-3 doubled the risk of major bleeding but was superior to aspirin alone for acute coronary syndrome’s adverse effects of death, non-fatal myocardial infarction and non-fatal thromboembolic events.