| Authors |
| van Es RF, Jonker JJC, Verheugt FWA, et al. |
| Title |
| Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial. |
| References |
| Lancet 2002;360:109-113. |
| Background |
| Both aspirin and warfarin reduces the recurrence of ischemic events post-MI, however it is unclear which antithrombotic therapy is best in the long term post-MI. |
| Purpose |
| To assess the efficacy of aspirin, high-intensity warfarin, and the combination of aspirin and moderate-intensity warfarin in patients with acute coronary syndrome. |
| Design |
- Multicenter, prospective, randomised, open-label trial.
- 999 patients post-MI or unstable angina (≤ 8 weeks)
|
| Exclusion Criteria |
| None. |
| Follow-Up |
| 12 months (mean) |
| Treatment Regimen |
| Aspirin (80 mg/day equivalent) or; Warfarin (target INR 3.0-4.0) or; Aspirin 80 mg/day plus warfarin (target INR 2.0-2.5) |
| Results |
Primary endpoint: Death/MI/stroke. Compared to aspirin alone, warfarin or warfarin plus aspirin significantly reduced the primary endpoint at a cost of increased minor bleeding risk. There was no significant difference in the primary endpoint in patients receiving combination therapy versus warfarin alone, however minor bleeding was increased. |
| Summary |
| In patients with recent acute coronary syndrome, treatment with high-intensity warfarin or the combination of aspirin and medium-intensity warfarin was more effective than aspirin alone in reducing the composite endpoint of death/MI/stroke, with a higher incidence of minor bleeding. There was no difference in the primary endpoint when comparing patients on combination therapy and warfarin. |
| Implications |
| None. |
| Related Figures |
| [18] |