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Effect of fixed low-dose warfarin added to aspirin in the long term after acute myocardial infarction the LoWASA Study

Herlitz, J; Holm, Johan LU ; Peterson, M; Karlson, BW; Evander, MH and Erhardt, Leif RW LU (2004) In European Heart Journal 25(3). p.232-239
Abstract
Aim To evaluate whether Long-term treatment with a fixed tow dose of warfarin in combination with aspirin improves the prognosis compared with aspirin treatment alone after an acute myocardial infarction (AMI). Methods Patients who were hospitalized for AMI were randomized to either 1.25 mg of warfarin plus 75 mg of aspirin (n=1659) daily or 75 mg of aspirin atone (n=1641). The study was performed according to the PROBE (Prospective Open Treatment and Blinded End Point Evaluation) design and was conducted at 31 hospitals in Sweden. The median follow-up time was 5.0 years. In the aspirin+warfarin group, 30.2% were permanently withdrawn as opposed to 14.0% in the aspirin group (P<0.0001). Analyses were performed on an intention-to-treat... (More)
Aim To evaluate whether Long-term treatment with a fixed tow dose of warfarin in combination with aspirin improves the prognosis compared with aspirin treatment alone after an acute myocardial infarction (AMI). Methods Patients who were hospitalized for AMI were randomized to either 1.25 mg of warfarin plus 75 mg of aspirin (n=1659) daily or 75 mg of aspirin atone (n=1641). The study was performed according to the PROBE (Prospective Open Treatment and Blinded End Point Evaluation) design and was conducted at 31 hospitals in Sweden. The median follow-up time was 5.0 years. In the aspirin+warfarin group, 30.2% were permanently withdrawn as opposed to 14.0% in the aspirin group (P<0.0001). Analyses were performed on an intention-to-treat basis. Results The combination of cardiovascular death, reinfarction or stroke was registered in 28.1% in the aspirin+warfarin group versus 28.8% in the aspirin group (NS). Cardiovascular deaths occurred in 14.2% in the aspirin+warfarin group vs 15.7% in the aspirin group (NS). Whereas no difference was found with regard to total mortality or reinfarction, those randomized to aspirin+warfarin had a reduced occurrence of stroke (4.7% vs 7.1%; P=0.004). The percentage of patients who suffered a serious bleed was 1.0% in the aspirin group vs 2.2% in the combination group (P=0.0006). Conclusion A fixed tow dose of warfarin added to aspirin in the Long term after AMI did not reduce the combined risk of cardiovascular death, reinfarction or stroke. The results did, however, indicate that a fixed low dose of warfarin added to aspirin reduced the risk of stroke, but this was a secondary end point. The combination of aspirin and warfarin was associated with an increased risk of bleeding. (C) 2003 Published by Elsevier Ltd on behalf of The European Society of Cardiology. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute myocardial, infarction, warfarin, prognosis
in
European Heart Journal
volume
25
issue
3
pages
232 - 239
publisher
Oxford University Press
external identifiers
  • pmid:14972424
  • wos:000189263900009
  • scopus:1242294440
ISSN
1522-9645
DOI
10.1016/j.ehj.2003.10.026
language
English
LU publication?
yes
id
6f264454-ab46-436a-bddd-647fe04c2399 (old id 899308)
date added to LUP
2008-01-10 16:53:34
date last changed
2017-09-03 04:31:49
@article{6f264454-ab46-436a-bddd-647fe04c2399,
  abstract     = {Aim To evaluate whether Long-term treatment with a fixed tow dose of warfarin in combination with aspirin improves the prognosis compared with aspirin treatment alone after an acute myocardial infarction (AMI). Methods Patients who were hospitalized for AMI were randomized to either 1.25 mg of warfarin plus 75 mg of aspirin (n=1659) daily or 75 mg of aspirin atone (n=1641). The study was performed according to the PROBE (Prospective Open Treatment and Blinded End Point Evaluation) design and was conducted at 31 hospitals in Sweden. The median follow-up time was 5.0 years. In the aspirin+warfarin group, 30.2% were permanently withdrawn as opposed to 14.0% in the aspirin group (P&lt;0.0001). Analyses were performed on an intention-to-treat basis. Results The combination of cardiovascular death, reinfarction or stroke was registered in 28.1% in the aspirin+warfarin group versus 28.8% in the aspirin group (NS). Cardiovascular deaths occurred in 14.2% in the aspirin+warfarin group vs 15.7% in the aspirin group (NS). Whereas no difference was found with regard to total mortality or reinfarction, those randomized to aspirin+warfarin had a reduced occurrence of stroke (4.7% vs 7.1%; P=0.004). The percentage of patients who suffered a serious bleed was 1.0% in the aspirin group vs 2.2% in the combination group (P=0.0006). Conclusion A fixed tow dose of warfarin added to aspirin in the Long term after AMI did not reduce the combined risk of cardiovascular death, reinfarction or stroke. The results did, however, indicate that a fixed low dose of warfarin added to aspirin reduced the risk of stroke, but this was a secondary end point. The combination of aspirin and warfarin was associated with an increased risk of bleeding. (C) 2003 Published by Elsevier Ltd on behalf of The European Society of Cardiology.},
  author       = {Herlitz, J and Holm, Johan and Peterson, M and Karlson, BW and Evander, MH and Erhardt, Leif RW},
  issn         = {1522-9645},
  keyword      = {acute myocardial,infarction,warfarin,prognosis},
  language     = {eng},
  number       = {3},
  pages        = {232--239},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal},
  title        = {Effect of fixed low-dose warfarin added to aspirin in the long term after acute myocardial infarction the LoWASA Study},
  url          = {http://dx.doi.org/10.1016/j.ehj.2003.10.026},
  volume       = {25},
  year         = {2004},
}