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Occult bleeding in three different antithrombotic regimes after myocardial infarction. A WARIS-II subgroup analysis

Mette Hurlen1, Lars Eikvar, Ingebjørg Seljeflot

  • 1Ullevål University Hospital, Norway. mehu@uus.no

Thrombosis Research
|September 6, 2005
PubMed

Insights

Long-term treatment with warfarin and aspirin did not cause anemia or iron deficiency. Occult bleeding was temporary and not clinically significant, with macroscopic bleeding being the main concern.

Area of Science:

  • Cardiology
  • Hematology
  • Pharmacology

Background:

  • Warfarin and aspirin are effective in preventing myocardial infarction (MI) recurrence.
  • Bleeding risk is a significant concern with these antithrombotic agents.
  • This study investigated occult bleeding and iron deficiency in patients on these therapies.

Purpose of the Study:

  • To compare the incidence of occult bleeding and iron deficiency.
  • To evaluate long-term effects of different antithrombotic regimens after MI.
  • To assess the clinical significance of occult bleeding detected through screening.

Main Methods:

  • 267 MI survivors were randomized to aspirin, warfarin, or combination therapy.
  • Occult bleeding in feces and urine was screened at 3 months.
  • Hemoglobin and iron metabolism were monitored at baseline, 3 months, and 4 years.

Main Results:

  • Occult bleeding occurred in 7.1% of fecal tests and 10.9% of urine tests, with no significant intergroup differences.
  • Most positive occult bleeding tests were transient; only 2 cases of malignancy were found.
  • Hemoglobin and iron status remained within normal limits across all groups throughout the 4-year follow-up.

Conclusions:

  • Long-term aspirin and/or warfarin therapy at studied doses did not lead to anemia or iron deficiency.
  • Occult bleeding was generally a temporary finding with limited clinical importance.
  • Macroscopic bleeding events are clinically significant; routine occult bleeding screening has limited value.
Abstract

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