Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, ON, Canada.
Thromb Res. 2011 Jun;127(6):513-7. doi: 10.1016/j.thromres.2011.02.010. Epub 2011 Mar 31.
Combination warfarin-ASA therapy is currently used in approximately 800,000 patients in North America as long-term treatment for the primary and secondary prevention of atherothrombotic and thromboembolic diseases. Despite a potentially complementary action of anticoagulant and antiplatelet drugs, the use of combination warfarin-ASA therapy is not based on compelling evidence of a net therapeutic benefit, with the exception of patients with a mechanical heart valve. On the other hand, there is more compelling and consistent evidence that combination warfarin-ASA therapy confers a 1.5- to 2.0-fold increased risk for serious bleeding compared with use of warfarin alone. In everyday practice, clinicians should combine the best available evidence with clinical judgment, considering that in most clinical scenarios, clinical practice guideline may not provide clear recommendations for patients who should, and should not, receive combination warfarin-ASA therapy. The objectives of this review are to describe which patients are receiving combined warfarin-aspirin therapy, to summarize the evidence for the therapeutic benefit and harm of combined warfarin-ASA therapy, and to suggest practical guidelines as to which patients should, and should not, receive such treatment.
在北美，约有 80 万名患者接受长期抗凝联合抗血小板治疗，用于动脉粥样硬化血栓形成和血栓栓塞性疾病的一级和二级预防。尽管抗凝和抗血小板药物具有潜在的协同作用，但联合应用华法林和阿司匹林的治疗方案并非基于确凿的净治疗获益证据，机械心脏瓣膜患者除外。另一方面，有更确凿和一致的证据表明，与单独使用华法林相比，联合应用华法林和阿司匹林使严重出血的风险增加 1.5 至 2.0 倍。在日常临床实践中，临床医生应将最佳现有证据与临床判断相结合，因为在大多数临床情况下，临床实践指南可能无法为应接受或不应接受联合华法林-阿司匹林治疗的患者提供明确建议。本综述的目的是描述正在接受华法林联合阿司匹林治疗的患者人群，总结联合应用华法林-阿司匹林的治疗获益和危害的证据，并提出哪些患者应接受、哪些患者不应接受这种治疗的实用建议。
