Document Detail


Less benefit from warfarin in diabetics after myocardial infarction?
MedLine Citation:
PMID:  18434719     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To examine the impact of prognostic factors on the outcome of treatment with warfarin or aspirin after acute myocardial infarction. METHODS: Patients from the Warfarin Aspirin Re-Infarction Study, assigned to treatment with warfarin (n = 1,216) or aspirin (n = 1,206) after myocardial infarction, were stratified according to important prognostic factors. Survival from the composite endpoint of death, myocardial infarction and thromboembolic stroke was estimated within each stratum by odds ratios (OR). The effect of therapy was then tested for heterogeneity across the two groups. Unadjusted analyses were complemented with regression analyses. RESULTS: In diabetics the OR was 1.54 (95% CI 0.80-2.94) compared to 0.75 (95% CI 0.60-0.93) in nondiabetic patients. The latter difference was statistically significant when testing for heterogeneity, suggesting effect modification of warfarin by diabetes. After adjusting for confounders, diabetic patients who received warfarin had a 56% excess risk of an endpoint as compared with those receiving aspirin. By contrast, nondiabetic patients on warfarin had a 22% lower risk of an endpoint than those allocated to aspirin. CONCLUSIONS: The present data suggest less benefit from warfarin as compared to aspirin in diabetics. The mechanisms behind this remain in question.
Authors:
Pål J Smith; Mette Hurlen; Michael Abdelnoor; Harald Arnesen
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2008-04-25
Journal Detail:
Title:  Cardiology     Volume:  111     ISSN:  1421-9751     ISO Abbreviation:  Cardiology     Publication Date:  2008  
Date Detail:
Created Date:  2008-09-26     Completed Date:  2009-01-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1266406     Medline TA:  Cardiology     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  161-6     Citation Subset:  IM    
Copyright Information:
Copyright 2008 S. Karger AG, Basel.
Affiliation:
Department of Internal Medicine, Asker and Baerum Hospital, Rud, Norway.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / administration & dosage*,  adverse effects
Aspirin / administration & dosage*,  adverse effects
Confounding Factors (Epidemiology)
Diabetes Complications / drug therapy*,  mortality,  prevention & control
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Myocardial Infarction / complications,  drug therapy*,  mortality,  prevention & control
Odds Ratio
Platelet Aggregation Inhibitors / administration & dosage*,  adverse effects
Prognosis
Proportional Hazards Models
Risk Factors
Stroke / complications,  mortality,  prevention & control
Survival Analysis
Thromboembolism / complications,  mortality,  prevention & control
Treatment Outcome
Warfarin / administration & dosage*,  adverse effects
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 81-81-2/Warfarin
Comments/Corrections
Comment In:
Cardiology. 2008;111(3):158-60   [PMID:  18434718 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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