Coumadin + aspirin no better than aspirin alone for PAD
Does adding an oral anticoagulant improve outcomes for patients with peripheral arterial disease?
Adding an oral anticoagulant to antiplatelet therapy in patients with lower extremity vascular disease or carotid artery disease does not improve cardiovascular outcomes and is associated with a significant increase in major bleeding. (LOE = 1b)
The Warfarin Antiplatelet Vascular Evaluation Trial Investigators, Anand S, Yusuf S, et al. Oral anticoagulant and antiplatelet therapy and peripheral arterial disease. N Engl J Med 2007;357:217-227. [PMID:17634457]
Randomized controlled trial (nonblinded)
Although antiplatelet therapy is routinely recommended for patients with peripheral arterial disease, it is unknown whether adding an oral anticoagulant would improve outcomes. These researchers identified 2417 adults between the ages of 35 years and 85 years with documented symptomatic lower extremity vascular disease or carotid artery disease (recent transient ischemic attack or stroke, carotid endarterectomy, or carotid stenosis > 50%). Patients were then given an antiplatelet agent (aspirin, ticlopidine, or clopidogrel at the discretion of their treating physician) and an oral anticoagulant (warfarin in 5 countries, acenocoumarol in 2 countries) for a 2-week to 4-week run-in period. The 2161 who were compliant, agreed to continue, and achieved a stable international normalized ratio between 2.0 and 3.0 were randomized with concealed allocation to receive either antiplatelet therapy alone or antiplatelet therapy plus oral anticoagulation. The patients' mean age was 64 years, 74% were men, and 82% had lower extremity vascular disease. Participants were followed for an average of 3 years, and although patients and physicians were not masked, outcomes were assessed by an independent team masked to treatment assignment. There was no difference between groups in either of the 2 composite outcomes (myocardial infarction, stroke, or cardiovascular death, or  myocardial infarction, stroke, severe coronary or peripheral ischemia, or cardiovascular death). However, there were more episodes of life-threatening bleeding (4.0% vs 1.2%; P < .001; number needed to treat to harm [NNTH] = 36) or moderate bleeding (2.9% vs 1.0%; P = .002; NNTH = 53) in the oral anticoagulant group.
Barry, Henry, et al., editors. "Coumadin + Aspirin No Better Than Aspirin Alone for PAD." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426314/all/Coumadin_+_aspirin_no_better_than_aspirin_alone_for_PAD.
Coumadin + aspirin no better than aspirin alone for PAD. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426314/all/Coumadin_+_aspirin_no_better_than_aspirin_alone_for_PAD. Accessed December 8, 2023.
Coumadin + aspirin no better than aspirin alone for PAD. (2019). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426314/all/Coumadin_+_aspirin_no_better_than_aspirin_alone_for_PAD
Coumadin + Aspirin No Better Than Aspirin Alone for PAD [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2023 December 08]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426314/all/Coumadin_+_aspirin_no_better_than_aspirin_alone_for_PAD.
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TY - ELEC T1 - Coumadin + aspirin no better than aspirin alone for PAD ID - 426314 ED - Barry,Henry, ED - Ebell,Mark H, ED - Shaughnessy,Allen F, ED - Slawson,David C, BT - EE+ POEM Archive UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426314/all/Coumadin_+_aspirin_no_better_than_aspirin_alone_for_PAD PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -