Warfarin superior to aspirin in heart attacks

Recent study has shown that the clot-fighting drug warfarin, alone or combined with aspirin, may work better than aspirin alone in preventing further cardiac problems after a heart attack. Warfarin belongs to a class of drugs known as anticoagulants, i.e. they help prevent blood clots from forming or growing larger, thereby cutting the risk of heart attack and the type of stroke caused by artery blockages. Some studies have suggested that warfarin beats aspirin in preventing repeat heart attacks, but others have found no difference. Aspirin, which works by keeping blood platelets from sticking together, is the more widely used drug, and by far the cheaper. The researchers from the University Hospital in Oslo, Norway carried out a randomised, trial in 3630 heart patients, 1216 received warfarin, 1206 received aspirin (160 mg daily), and 1208 received aspirin (75 mg daily) combined with warfarin. The mean duration of observation was four years. By the end of this period, 20% of patients on aspirin alone had died or suffered a heart attack or stroke, compared with less than 17% of warfarin patients and 15% of those on both drugs. They calculated that patients on the drug combination were 29% less likely to have a heart attack or stroke or to die than patients who were on aspirin alone. Researchers also found that the drug carries a higher risk of major bleeding than aspirin does, although relatively few patients overall had serious bleeding episodes. As aspirin and warfarin hinder the blood's ability to clot, abnormal bleeding is a concern in using them. In this study, warfarin patients were more likely to have major bleeds, such as bleeding in the brain or gastrointestinal tract. Minor bleeding, such as nosebleeds, was most common in patients on the drug combination. It can be concluded that warfarin, in combination with aspirin or given alone, was superior to aspirin alone in reducing the incidence of composite events after an acute heart attack but was associated with a higher risk of bleeding.