| Warfarin plus aspirin after myocardial infarction or the acute coronary syndrome: meta-analysis with estimates of risk and benefit. | |
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MedLine Citation:
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PMID: 16103468 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: After the acute coronary syndrome, adding warfarin to standard aspirin therapy decreases myocardial infarction and stroke but increases major bleeding. PURPOSE: To quantify the risks and benefits of warfarin therapy after the acute coronary syndrome. DATA SOURCES: MEDLINE from 1990 to October 2004. Additional data were obtained from study authors. Clinical risk factors were used to classify hypothetical patients into cardiovascular and bleeding risk groups on the basis of published data. STUDY SELECTION: Randomized trials comparing intensive warfarin therapy (international normalized ratio > 2.0) plus aspirin with aspirin alone after the acute coronary syndrome. DATA EXTRACTION: Two reviewers independently selected studies and extracted data on study design; quality; and clinical outcomes, including myocardial infarction, stroke, revascularization, death, and major and minor bleeding. Rate ratios for outcomes were calculated and pooled by using the method of DerSimonian and Laird. DATA SYNTHESIS: Ten trials involving a total of 5938 patients (11,334 patient-years) met the study criteria. Compared with aspirin alone, warfarin plus aspirin was associated with a decrease in the annual rate of myocardial infarction (0.022 vs. 0.041; rate ratio, 0.56 [95% CI, 0.46 to 0.69]), ischemic stroke (0.004 vs. 0.008; rate ratio, 0.46 [CI, 0.27 to 0.77]), and revascularization (0.115 vs. 0.135; rate ratio, 0.80 [CI, 0.67 to 0.95]). Warfarin was associated with an increase in major bleeding (0.015 vs. 0.006; rate ratio, 2.5 [CI, 1.7 to 3.7]). Mortality did not differ. LIMITATIONS: Two large studies provided most of the data. Studies did not include coronary stenting, and results should not be applied to patients with stents. Relative risk reductions may not be consistent across risk groups. CONCLUSIONS: For patients with the acute coronary syndrome who are at low or intermediate risk for bleeding, the cardiovascular benefits of warfarin outweigh the bleeding risks. |
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Authors:
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Michael B Rothberg; Carmel Celestin; Louis D Fiore; Elizabeth Lawler; James R Cook |
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Publication Detail:
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Type: Journal Article; Meta-Analysis |
Journal Detail:
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Title: Annals of internal medicine Volume: 143 ISSN: 1539-3704 ISO Abbreviation: Ann. Intern. Med. Publication Date: 2005 Aug |
Date Detail:
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Created Date: 2005-08-16 Completed Date: 2005-08-31 Revised Date: 2007-01-29 |
Medline Journal Info:
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Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 241-50 Citation Subset: AIM; IM |
Affiliation:
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Division of General Medicine and Geriatrics, Baystate Medical Center, Springfield, Massachusetts 01199, USA. Michael.Rothberg@bhs.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Anticoagulants / adverse effects, therapeutic use* Aspirin / adverse effects, therapeutic use* Coronary Disease / prevention & control* Female Fibrinolytic Agents / adverse effects, therapeutic use* Hemorrhage / chemically induced Humans Male Middle Aged Myocardial Infarction / prevention & control* Recurrence / prevention & control Risk Assessment Syndrome Warfarin / adverse effects, therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Fibrinolytic Agents; 50-78-2/Aspirin; 81-81-2/Warfarin |
| Comments/Corrections | |
Comment In:
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Evid Based Med. 2006 Apr;11(2):43
[PMID:
17213073
]
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Summary for patients in:
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Ann Intern Med. 2005 Aug 16;143(4):I14
[PMID:
16103464
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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