Warfarin, aspirin, or both after myocardial infarction.
Warfarin, aspirin, or both after myocardial infarction.
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DOI：
10.1056/nejmoa020496
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发表时间：
2002-09-26
影响因子：
158.5
通讯作者：
Arnesen, H
中科院分区：
文献类型：
--
作者：
Hurlen, M;Abdelnoor, M;Arnesen, H
背景：抗血栓治疗在心肌梗死后二级预防中的作用已得到充分证实。尽管现有文献表明华法林上级优于阿司匹林，但阿司匹林是目前使用更广泛的药物。我们研究了心肌梗死后华法林、阿司匹林或两者合用的有效性和安全性。在一项3630例患者的随机多中心试验中，1216例患者接受华法林治疗（剂量旨在达到2.8至4.2的国际标准化比值[INR]），1206例接受阿司匹林治疗1208例接受阿司匹林（每日75 mg）联合华法林（旨在达到INR 2.0至2.5的剂量）。平均观察时间为4年。结果：1206例接受阿司匹林治疗的患者中，有241例发生主要结局，包括死亡、非致命性再梗死或血栓栓塞性脑卒中（20.0%），1216例中有203例接受华法林治疗（16.7%;与阿司匹林相比的率比，0.81; 95%置信区间，0.69至0.95; P=0.03），1208例接受华法林和阿司匹林的患者中有181例（15.0%;与阿司匹林相比的率比为0.71; 95%置信区间为0.60至0.83; P=0.001）。两组接受华法林治疗的差异无统计学意义。在华法林组和阿司匹林组中，每治疗年有0.62%的患者发生严重的非致命性出血，而阿司匹林组为0.17%（P <0.05）。
Background: The role of antithrombotic therapy in secondary prevention after myocardial infarction is well established. Although the available literature suggests that warfarin is superior to aspirin, aspirin is currently the more widely used drug. We studied the efficacy and safety of warfarin, aspirin, or both after myocardial infarction.Methods: In a randomized, multicenter trial in 3630 patients, 1216 received warfarin (in a dose intended to achieve an international normalized ratio [INR] of 2.8 to 4.2), 1206 received aspirin (160 mg daily), and 1208 received aspirin (75 mg daily) combined with warfarin (in a dose intended to achieve an INR of 2.0 to 2.5). The mean duration of observation was four years.Results: The primary outcome, a composite of death, nonfatal reinfarction, or thromboembolic cerebral stroke, occurred in 241 of 1206 patients receiving aspirin (20.0 percent), 203 of 1216 receiving warfarin (16.7 percent; rate ratio as compared with aspirin, 0.81; 95 percent confidence interval, 0.69 to 0.95; P=0.03), and 181 of 1208 receiving warfarin and aspirin (15.0 percent; rate ratio as compared with aspirin, 0.71; 95 percent confidence interval, 0.60 to 0.83; P=0.001). The difference between the two groups receiving warfarin was not statistically significant. Episodes of major, nonfatal bleeding were observed in 0.62 percent of patients per treatment-year in both groups receiving warfarin and in 0.17 percent of patients receiving aspirin (P