Canadian researchers have found that adding warfarin to aspirin therapy in peripheral arterial disease (PAD) adds no therapeutic benefit relative to cardiovascular (CV) events but greatly increases the number of life-threatening bleeds. This large study of 2000 patients in 7 countries randomized patients to receive aspirin alone or aspirin and warfarin titrated to an international normalized ratio of 1.8 to 3.5. None of the primary end points (CV death, myocardial infarction, stroke, and severe ischemia) showed any significant benefit in favor of the combination. The combination therapy in PAD, however, resulted in a significant increase in life-threatening and moderate bleeds, including a 15-fold increase in the risk of hemorrhagic stroke.
Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Care in High Point, NC.