ASPECTAnticoagulants in the Secondary Prevention of Events in Coronary Thrombosis |
| Authors: |
(a) Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis (ASPECT) research group
(b) Azar AJ, Cannegieter SC, Deckers JW, Briët E, van Bergen PFMM, Jonker JJC, Rosendaal FR |
| Titles: |
(a) Effect of long-term oral anticoagulant treatment on mortality and cardiovascular morbidity after myocardial infarction
(b) Optimal intensity of oral anticoagulant therapy after myocardial infarction |
| References: |
(a) Lancet 1994;343:499-503
(b) J Am Coll Cardiol 1996;27:1349-55 |
| Disease: |
AM:1349-55 |
| Disease: |
AMI |
| Purpose: |
To assess the effect of long-term treatment with oral anticoagulants in the secondary prevention of mortality and morbidity after AMI |
| Study Design: |
Randomised, double-blind, placebo- controlled |
| Follow-up: |
0.5-6 years (mean 3 years) |
| Patients: |
3404 survivors of MI (1700 anticoagulants and 1704 placebo), enrolled within 6 weeks after hospital discharge |
| Treatmentregimen: |
Coumarins (nicoumalone or phenprocoumon) to achieve an international normalised ratio of 2.4-4.8, or placebo |
| Results: |
There were 170 deaths among the anticoagulant-treated patients and 189 in the placebo group. Compared to placebo, long-term anticoagulant therapy led to a significant reduction in recurrent MI and cerebrovascular events. Major bleeding complications were seen in 73 patients who received anticoagulants and 19 patients who received placebo. The incidence of the combined outcome (bleeding or thromboembolic complications) was lower with international normalised ratios between 2 and 4 than with international normalised ratios of < 2 or > 4, and was lowest with an international normalised ratio of 3-4 (3.2 events/100 patient-years) |
