Document Detail

Long-term effect of chronic oral anticoagulation with warfarin after acute myocardial infarction.
MedLine Citation:
PMID:  20193834     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Antiplatelet therapy is the principal component of the antithrombotic regimen after acute myocardial infarction. It remains unclear whether additional chronic oral anticoagulation (OAC) improves outcomes. We set out to evaluate the risk and benefit of long-term OAC after myocardial infarction. METHODS: We pooled 10 randomized clinical trials comparing warfarin-containing regimens (OAC) with or without aspirin with non-OAC regimens with or without aspirin (No OAC) for patients with recent infarction. The primary endpoint was all-cause mortality. Other endpoints included recurrent infarction, stroke, and major bleeding. We calculated the odds ratio (OR) (fixed effect, OR <1 indicates benefit for OAC) for death and other ischemic and hemorrhagic complications at the longest interval of follow-up available. RESULTS: Among 24,542 patients, 14,062 were assigned to OAC and 10,480 to no OAC. The patients were followed for 3-63 months, for 89,562 patient-years. Death occurred in 2424 patients (9.9%), 1279 OAC patients, and 1145 in the no OAC group, OR 0.97 (95% confidence interval [CI], 0.88-1.05), P=.43. Similarly, there was no effect on recurrent infarction. Stroke occurred in 578 patients (2.4%), 271 in the OAC group and 307 in the no OAC group, OR 0.75 (95% CI, 0.63-0.89), P=.001. There was substantially more major bleeding (OR 1.83 [95% CI, 1.50-2.23], P <.001) in the OAC group. Separate analyses, performed for patients (n=11,920) randomized to aspirin versus aspirin and OAC yielded very similar results. CONCLUSION: As compared with placebo or aspirin, OAC with or without aspirin does not reduce mortality or reinfarction, reduces stroke, but is associated with significantly more major bleeding.
Salman A Haq; John F Heitner; Terrence J Sacchi; Sorin J Brener
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  The American journal of medicine     Volume:  123     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-02     Completed Date:  2010-04-06     Revised Date:  2010-11-05    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  250-8     Citation Subset:  AIM; IM    
Copyright Information:
2010 Elsevier Inc. All rights reserved.
New York Methodist Hospital, Brooklyn, 11215, USA.
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MeSH Terms
Administration, Oral
Anticoagulants / administration & dosage*
Cause of Death
Follow-Up Studies
Myocardial Infarction / drug therapy*,  mortality,  physiopathology
Survival Rate / trends
Time Factors
Treatment Outcome
United States / epidemiology
Warfarin / administration & dosage*
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin
Comment In:
Am J Med. 2010 Nov;123(11):e13; author reply e15   [PMID:  20843502 ]

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

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