Skip Navigation
American College of Physicians Logo
  • Subscribe
  • Submit a Manuscript
  • Sign In
    Sign in below to access your subscription for full content
    INDIVIDUAL SIGN IN
    Sign In|Set Up Account
    You will be directed to acponline.org to register and create your Annals account
    INSTITUTIONAL SIGN IN
    Open Athens|Shibboleth|Log In
    Annals of Internal Medicine
    SUBSCRIBE
    Subscribe to Annals of Internal Medicine.
    You will be directed to acponline.org to complete your purchase.
Annals of Internal Medicine Logo Menu
  • Latest
  • Issues
  • Channels
  • CME/MOC
  • In the Clinic
  • Journal Club
  • Web Exclusives
  • Author Info
Advanced Search
  • ‹ PREV ARTICLE
  • This Issue
  • NEXT ARTICLE ›
Summaries for Patients |16 August 2005

Benefits and Harms of Warfarin plus Aspirin after Acute Coronary Events

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information

  • The summary below is from the full report titled “Warfarin plus Aspirin after Myocardial Infarction or the Acute Coronary Syndrome: Meta-Analysis with Estimates of Risk and Benefit.” It is in the 16 August 2005 issue of Annals of Internal Medicine (volume 143, pages 241-250). The authors are M.B. Rothberg, C. Celestin, L.D. Fiore, E. Lawler, and J.R. Cook.


Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
×
  • ‹ PREV ARTICLE
  • This Issue
  • NEXT ARTICLE ›
Jump To
  • Full Article
  • FULL ARTICLE
  • FULL ARTICLE
    • What is the problem and what is known about it so far?
    • Why did the researchers do this particular study?
    • Who was studied?
    • How was the study done?
    • What did the researchers find?
    • What were the limitations of the study?
    • What are the implications of the study?
  • Figures
  • Tables
  • Supplements
  • Audio/Video
  • Summary for Patients
  • Clinical Slide Sets
  • CME / MOC
  • Comments
  • Twitter Link
  • Facebook Link
  • Email Link
More
  • LinkedIn Link

What is the problem and what is known about it so far?

Clogged heart arteries can cause acute coronary events, such as heart attacks or worsening chest pain (unstable angina). Many middle-aged and older adults have these life-threatening events. They are a major cause of medical care and hospitalization in developed countries. Adults who survive the events often have high risks for blood clots in the heart's arteries and for repeated events. Doctors usually prescribe aspirin to help prevent further clots and repeated events. They may also prescribe a “blood thinner” (warfarin) or both aspirin and warfarin. Warfarin requires frequent monitoring and sometimes causes problems with bleeding. Doctors sometimes wonder if giving both aspirin and warfarin leads to more harms than benefits.

Why did the researchers do this particular study?

To summarize literature about the benefits and harms of warfarin plus aspirin for people who have had an acute coronary event.

Who was studied?

5938 adults included in 10 randomized trials. All had either a heart attack or unstable angina. None received stent procedures to open up blocked blood vessels.

How was the study done?

The authors looked for studies published between 1990 and October 2004. They selected randomized trials that compared regular-intensity warfarin (international normalized ratio > 2.0) plus aspirin with aspirin alone in patients with acute coronary events. They combined data from these studies to estimate chances of benefits (reductions in heart attacks, ischemic strokes, and heart artery procedures) and harms (major bleeding events). They then applied numbers from the combined benefit and harm data (rate ratios) to a large population-based study that included many patients with different risks for heart events and bleeding. The researchers estimated groups of people for whom warfarin plus aspirin might be more helpful than harmful.

What did the researchers find?

Compared with aspirin alone, warfarin plus aspirin decreased annual rates of heart attacks, ischemic strokes, and heart artery procedures. Warfarin plus aspirin increased annual rates of major bleeding. Patients with several risk factors, such as older age, diabetes, heart failure, and decreased kidney function, had the highest risks for heart attacks and strokes. Older patients who previously had a stroke, gastrointestinal bleeding episode, kidney disease, or atrial fibrillation were at higher risk for bleeding. Numbers of deaths did not differ between treatments. In patients with low or average risk for bleeding, the numbers of heart and stroke events prevented with combination therapy exceeded the numbers of major bleeding episodes that it caused.

What were the limitations of the study?

Doctors treat many patients with acute coronary events with stents. They don't use warfarin in these patients because of bleeding risks associated with the stent procedure. This review's findings do not apply to patients treated with stents. Also, the researchers sometimes used assumptions when they applied data to different patient groups.

What are the implications of the study?

Benefits of warfarin plus aspirin may outweigh harms for some patients with acute coronary events who are not stented and do not have high bleeding risks.

This feature is available only to Registered Users

Subscribe/Learn More
Submit a Comment

0 Comments

PDF
Not Available
Citations
Citation

Benefits and Harms of Warfarin plus Aspirin after Acute Coronary Events. Ann Intern Med. 2005;143:I–14. doi: https://doi.org/10.7326/0003-4819-143-4-200508160-00001

Download citation file:

  • Ris (Zotero)
  • EndNote
  • BibTex
  • Medlars
  • ProCite
  • RefWorks
  • Reference Manager

© 2020

×
Permissions

Published: Ann Intern Med. 2005;143(4):I-14.

DOI: 10.7326/0003-4819-143-4-200508160-00001

©
2005 American College of Physicians
0 Citations
Advertisement

See Also
Warfarin plus Aspirin after Myocardial Infarction or the Acute Coronary Syndrome: Meta-Analysis with Estimates of Risk and Benefit
View MoreView Less

Related Articles
Update in General Internal Medicine: Evidence Published in 2016
Annals of Internal Medicine; 166 (7): W11-W15
Update in General Internal Medicine: Evidence Published in 2012
Annals of Internal Medicine; 158 (8): 615-619
Warfarin and aspirin did not differ for death or stroke in heart failure and sinus rhythm
Annals of Internal Medicine; 157 (4): JC2-7
Update in Cardiology
Annals of Internal Medicine; 152 (12): 786-791
View MoreView Less

Journal Club
Warfarin and aspirin did not differ for death or stroke in heart failure and sinus rhythm
Annals of Internal Medicine; 157 (4): JC2-7
In embolic stroke of undetermined source, rivaroxaban vs aspirin did not reduce recurrence and increased bleeding
Annals of Internal Medicine; 169 (6): JC32
Review: DOACs reduce intracranial hemorrhage more than warfarin in AF with CKD
Annals of Internal Medicine; 168 (4): JC18
In stable CVD, rivaroxaban plus aspirin reduced CV events and increased bleeding compared with aspirin alone
Annals of Internal Medicine; 167 (10): JC52
View MoreView Less

Related Topics
Acute Coronary Syndromes
Cardiology
Coronary Heart Disease
Emergency Medicine

Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine.

PubMed Articles
Platelet Function: Meloxicam Intravenous in Whole Blood Samples From Healthy Volunteers.
Clin Pharmacol Drug Dev 2020.
[Gastroenterology and hepatology in 2019].
Rev Med Suisse 2020;16(676-7):34-36.
View More

Results provided by: PubMed

Advertisement
CME/MOC Activity Requires Users to be Registered and Logged In.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
The Comments Feature Requires Users to be Registered and Logged In.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
link to top

Content

  • Home
  • Latest
  • Issues
  • Channels
  • CME/MOC
  • In the Clinic
  • Journal Club
  • Web Exclusives

Information For

  • Author Info
  • Reviewers
  • Press
  • Readers
  • Institutions / Libraries / Agencies
  • Advertisers

Services

  • Subscribe
  • Renew
  • Alerts
  • Current Issue RSS
  • Latest RSS
  • In the Clinic RSS
  • Reprints & Permissions
  • Contact Us
  • Help
  • About Annals
  • About Mobile
  • Patient Information
  • Teaching Tools
  • Annals in the News
  • Share Your Feedback

Awards and Cover

  • Personae (Cover Photo)
  • Junior Investigator Awards
  • Poetry Prize

Other Resources

  • ACP Online
  • Career Connection
  • ACP Advocate Blog
  • ACP Journal Wise

Follow Annals On

  • Twitter Link
  • Facebook Link
acp link acp
silverchair link silverchair

Copyright © 2020 American College of Physicians. All Rights Reserved.

Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Privacy Policy

|

Conditions of Use

This site uses cookies. By continuing to use our website, you are agreeing to our privacy policy. | Accept
×

You need a subscription to this content to use this feature.

×
PDF Downloads Require Access to the Full Article.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
INSTITUTIONAL SIGN IN
Open Athens|Shibboleth|Log In
Annals of Internal Medicine
PURCHASE OPTIONS
Buy This Article|Subscribe
You will be redirected to acponline.org to sign-in to Annals to complete your purchase.
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
Access to this Free Content Requires Users to be Registered and Logged In. Please Choose One of the Following Options
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×