Letters to the Editor
Warfarin and antiplatelet drugs
- Con Aroney, Peter Thompson, Lye Lin Ho, Timothy Brighton
- Aust Prescr 2002;25:131-2
- 1 December 2002
- DOI: 10.18773/austprescr.2002.127
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Editor, – We read with interest the article 'Warfarin, antiplatelet drugs and their interactions' (Aust Prescr 2002;25:81-5) and were disappointed that although the authors emphasise the risks of combining warfarin with aspirin, they fail to acknowledge the proven benefits of this combination in patients with prosthetic heart valves. A recent meta-analysis1 showed that compared with anticoagulation alone, the addition of an antiplatelet drug reduced the risk of not only thromboembolic events (odds ratio 0.41, p < 0.001)but also total mortality (odds ratio 0.49, p < 0.001).
The old view that the combination is dangerous is still held by many doctors and pharmacists. We certainly agree with the authors' recommendation that with the combination, low-dose aspirin should be used and the INR 'kept at the lower end of the desired target', and that patients on the combination should be carefully monitored for possible bleeding complications, including gastrointestinal blood loss. However, the evidence that adding low-dose aspirin to warfarin reduces total mortality by 50% in these patients should not be ignored and needs wide dissemination.
Associate Professor of Medicine
University of Queensland
Prince Charles Hospital
Professor of Medicine and Public Health
University of Western Australia
Associate Professor of Medicine, University of Queensland, Cardiology Department, Prince Charles Hospital Brisbane
Professor of Medicine and Public Health, University of Western Australia, Perth
Haematology Registrar, Department of Haematology, South East Area Laboratories Services, St George Hospital, Kogarah, New South Wales
Staff Specialist, Department of Haematology, South East Area Laboratories Services, St George Hospital, Kogarah, New South Wales