American Heart Association Comment:Lancet (Jan. 24, 1998) report titled "Thrombosis prevention trial; randomized trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men and increased risk"
A combination anticoagulant treatment -- low-dose aspirin and low-dose warfarin -- reduced the risk of heart attack by 34 percent in a 13-year study involving 5,499 men.
Valentin Fuster, M.D., Ph.D., president-elect of the American Heart Association, says the study's findings "open the door" to the exploration of new treatments for preventing heart attack deaths in healthy individuals at high risk. Other studies that have looked at a double-drug approach of aspirin and warfarin but have not found such positive results. "The researchers in the study were able to develop the right dosage so that the benefits outweighed the risk, " says Fuster, director of the Cardiovascular Institute at Mount Sinai Medical Center, New York City. "The use of anticoagulation treatment is a balancing act; it appears they have found the right balance."
Individuals with high blood pressure taking both drugs had the highest risk for bleeding in the brain. "We need to be more concerned about an increased risk of adverse reactions, including hemorrhagic stroke, for individuals who have high blood pressure," says Fuster. Furthermore, because the study was conducted in middle-aged, high-risk men, the benefits of the treatment for other groups, including women, must await further study.
"The study still does not answer the question of whether warfarin and aspirin should be given to healthy individuals without known risk factors," says Fuster. Policy and clinical decisions cannot be based on one study, and physicians still must make individual judgments and weigh the risk and benefits.