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The Clinical Impact of Administering Warfarin to Post-Myocardial Infarction Patients

College of Pharmacy, University of Toledo, Ohio.

Vincent F. Mauro, PharmD, FCCP

University of Toledo, Ohio., vmauro{at}utnet.utoledo.edu

This article reviews recent trials that have compared aspirin to anticoagulation in post-myocardial infarction (MI) patients. Warfarin dosed to international normalized ratios (INRs) between 2.8 and 4.2 was superior to placebo in reducing morbidity and mortality; however, post-MI patients are generally receiving aspirin. When aspirin therapy was compared to warfarin plus aspirin, no clinical benefit occurred when warfarin was dosed to achieve INRs less than 2.0. In contrast, warfarin reduced morbidity and mortality compared to aspirin when it was dosed as monotherapy to achieve INRs between 3.0 and 4.0 or used with aspirin 75 to 80 mg daily and dosed to INRs between 2.0 and 2.5. With respect to mortality alone, warfarin was superior to aspirin only when it was used as monotherapy and compared to aspirin 80 mg daily. No difference in mortality was observed when warfarin monotherapy was compared to aspirin 160 mg daily.

Key Words: Myocardial infarction • warfarin • aspirin • secondary prevention • anticoagulation

Journal of Pharmacy Practice, Vol. 17, No. 4, 266-269 (2004)
DOI: 10.1177/0897190004268652


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