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Published on: February 3, 2021

Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial

Robert F van Es1, Jan J C Jonker, Freek W A Verheugt

  • 1Julius Centre for General Practice and Patient Oriented Research, University Medical Centre Utrecht, Netherlands.

Lancet (London, England)
|July 20, 2002
PubMed

Insights

Oral anticoagulants or combination therapy with aspirin and anticoagulants are more effective than aspirin alone for reducing cardiovascular events after myocardial infarction. Combination therapy increased minor bleeding risk.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Aspirin and oral anticoagulants are used to prevent recurrent ischemic events post-myocardial infarction.
  • Optimal long-term antiplatelet and anticoagulant strategies require further investigation.
  • Balancing efficacy and bleeding risk is crucial in managing acute coronary events.

Purpose of the Study:

  • To compare the long-term effectiveness of aspirin, oral anticoagulants, and combination therapy after acute coronary events.
  • To assess the safety profile, particularly bleeding risk, associated with each treatment strategy.

Main Methods:

  • A randomized open-label trial involving 999 patients across 53 sites.
  • Patients were assigned to low-dose aspirin, high-intensity oral anticoagulation, or combined low-dose aspirin and moderate-intensity oral anticoagulation.
  • Follow-up extended to 26 months, with the primary endpoint being myocardial infarction, stroke, or death.

Main Results:

  • Combination therapy (aspirin + anticoagulants) and oral anticoagulants alone showed greater efficacy in reducing the primary endpoint compared to aspirin alone (p=0.03 and p=0.0479, respectively).
  • Major bleeding rates were similar across all groups.
  • Minor bleeding occurred more frequently in the combination therapy group (15%) compared to aspirin (5%) or anticoagulants alone (8%).

Conclusions:

  • High-intensity oral anticoagulants or combined aspirin and moderate-intensity oral anticoagulants are more effective than aspirin alone for reducing cardiovascular events and death post-acute coronary events.
  • While effective, combination therapy is associated with an increased risk of minor bleeding.
  • Treatment decisions should weigh the benefits of reduced ischemic events against the increased risk of bleeding.
Abstract

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