Canadian researchers have foundthat adding warfarin to aspirin therapyin peripheral arterial disease (PAD) addsno therapeutic benefit relative to cardiovascular(CV) events but greatly increasesthe number of life-threateningbleeds. This large study of 2000 patientsin 7 countries randomized patients toreceive aspirin alone or aspirin and warfarintitrated to an international normalizedratio of 1.8 to 3.5. None of the primaryend points(CV death, myocardialinfarction,stroke, and severeischemia) showedany significant benefit in favor of thecombination. The combination therapyin PAD, however, resulted in a significantincrease in life-threatening and moderatebleeds, including a 15-fold increasein the risk of hemorrhagic stroke.
Dr. Garrett is a clinical pharmacistpractitioner at Cornerstone Health Carein High Point, NC.