Issue 143 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