Aspirin and warfarin versus aspirin monotherapy after myocardial infarction.

OBJECTIVE: To review data concerning combined aspirin/warfarin versus aspirin alone for secondary prevention after myocardial infarction (MI).

DATA SOURCES: Literature was accessed through MEDLINE (1966-September 2002). Search terms included aspirin, warfarin, secondary prevention, and myocardial infarction.

DATA SYNTHESIS: Despite use of low-dose aspirin after an MI, risk of subsequent death and ischemic events remains high, making strategies for secondary prevention imperative. Relevant, large, long-term studies focusing on dual aspirin/warfarin versus aspirin alone in post-MI patients were evaluated.

CONCLUSIONS: Aspirin 75-325 mg/d should remain first-line therapy for secondary prevention after MI. Combining aspirin 75-81 mg with warfarin to maintain the international normalized ratio at 2.0-2.5 may provide added benefit, but should be considered only for patients at high risk for thromboembolic events.