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Item #11
Aspirin
Vs. Warfarin After Heart Attack
Warfarin
-- either alone or in combination with aspirin -- was superior to
aspirin alone in decreasing the risk of composite events after acute
MI, but……………
To
evaluate the benefits of aspirin vs warfarin after myocardial
infarction (MI), they studied 3630 post-MI patients who received
warfarin (INR ratio = 2.8-4.2; n = 1216), 160 mg aspirin plus warfarin
(n = 1206), or 75 mg aspirin (n = 1206) daily. The mean follow-up was
4 years, and the primary outcome was a composite of death, nonfatal
reinfarction, or thromboembolic cerebral stroke.
They
found that warfarin -- either alone or in combination with aspirin --
was superior to aspirin alone in decreasing the risk of composite
events after acute MI. However, there was a major drawback to warfarin
therapy: it was associated with a greater incidence of bleeding.
The
treatment decision must lie with the practitioner, who must balance
carefully the benefits of warfarin therapy with the risks of bleeding.
Before a patient can be prescribed warfarin, the physician must
determine whether the patient is able to take and manage the long-term
use of warfarin. This question is especially important when treating
elderly patients.
J.
Willis Hurst, MD, Consultant of the Division of Cardiology, Emory
University School of Medicine; Former Professor and Chairman,
Department of Medicine 1957-1986
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YOU KNOW
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of stroke is 2-4 times higher; 60%-65% have high blood pressure; and
60%-70% have mild to severe diabetic nerve damage.
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