Treatment
Review: oral anticoagulants plus aspirin reduce arterial thromboembolism more than oral anticoagulants alone but only in patients with mechanical heart valves
Dentali F, Douketis JD, Lim W, et al. Combined aspirin–oral anticoagulant therapy compared with oral anticoagulant therapy alone among patients at risk for cardiovascular disease: a meta-analysis of randomized trials. Arch Intern Med 2007;167:117–24.
Q In adults requiring oral anticoagulant (OAC) therapy, what is the relative efficacy and safety of OACs plus aspirin compared with OACs alone?
Key Words: anticoagulants • aspirin • platelet aggregation inhibitors • haemorrhage • thromboembolism
| The first 150 words of the full text of this article appear below. |
Data sources:
Medline (1966 to June 2005), EMBASE/Excerpta Medica (1980 to June 2005), Cochrane Central Register of Controlled Trials (Issue 2, 2005), reference lists, and experts.
Study selection and assessment:
randomised controlled trials (RCTs) that compared OACs plus aspirin with OACs alone (where OACs were administered to achieve the same target international normalised ratio [INR] or with the same fixed dose in both treatment arms) in adults requiring OAC therapy and that reported 
1 of 3 prespecified outcomes (see below) at 3 months follow up. 10 trials (n = 4180) met the selection criteria. 4 trials were rated as high quality (>2 of 4 points), and 6 were rated as low quality (
2 points) based on generation of randomisation sequence, method of double blinding, and patient withdrawals and dropouts.
Outcomes:
arterial thromboembolism (myocardial infarction, unstable angina requiring hospital admission, stroke, transient ischaemic attack, or systemic embolism), mortality, and major
Kingston General Hospital,
Kingston, Ontario, Canada
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