Low-dose combo no better than aspirin alone in secondary prevention

DALLAS, Feb. 5 Giving heart attack patients a combined low dose of the anticoagulant drug warfarin with low-dose aspirin does not prevent second heart attacks or strokes better than aspirin alone, researchers report in todays Circulation: Journal of the American Heart Association.

A study among heart attack patients at 78 Veterans Administration medical centers found the blood-thinning benefits of daily aspirin are not enhanced by concurrent treatment with low doses of the more expensive blood thinner warfarin (Coumadin), which is given to reduce risk of bleeding, report principal researchers Louis D. Fiore, M.D., and Michael D. Ezekowitz, M.D., Ph.D. We had hoped this might double the effectiveness of the drugs, but it didnt, says Fiore. Lower anticoagulant levels of warfarin simply had no effect on preventing subsequent heart attacks or strokes. It was a bust.

Both drugs slow blood clotting. Blood clots can block vessels that carry blood to the heart, causing a heart attack, or to the brain, causing an ischemic stroke. Aspirin affects the blood platelets. Warfarin inhibits circulating clotting proteins in the blood.

Many clinicians say that warfarin may be a better blood thinner than aspirin in preventing heart attacks and strokes. However, warfarin costs more and is associated with a higher risk of bleeding. Recent studies have found that regular use of aspirin may reduce the risk of coronary heart disease (CHD) by 28 percent in people who have never had a heart attack or stroke, but who are at increased risk. Those considered at increased risk are men over age 40, post-menopausal women, and younger persons with CHD risk factors (smoking, diabetes, hypertension, etc.).

Fiore and colleagues at the Department of Veterans Affairs Cooperative Study Program, in New Haven, Conn., conducted a randomized, open-label study comparing aspirin alone with combined aspirin and warfarin in preventing death, second heart attacks, strokes and majo

Contact: Carole Bullock
American Heart Association

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