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Benefits of warfarin after myocardial infarction outweigh the risks

Doctors are often reluctant to start their patients on warfarin even in circumstances when well established guidelines recommend it. They worry about the inconvenience to the patient and that the increased risk of bleeding may offset any benefit. So despite evidence from randomised controlled trials that adding warfarin to aspirin is beneficial in the secondary prevention of myocardial infarction, the treatment has not been adopted widely. A recent meta-analysis provides a more precise estimate of risks and benefits and may stimulate a change in practice.

Credit: ANNALS OF MEDICINE INTERNAL

Ten trials involving over 11 000 patient years of observation met criteria for inclusion, although the lion's share of the data was provided by the two largest studies. Overall, the combination of warfarin and aspirin led to about a halving of risk of myocardial infarction and ischaemic stroke compared with aspirin alone, but the risk of major …