Meade T W, Miller G J
MRC Epidemiology and Medical Care Unit, Wolfson Institute of Preventative Medicine, Medical College, St. Bartholomew's Hospital, London, United Kingdom.
Am J Cardiol. 1995 Feb 23;75(6):23B-26B. doi: 10.1016/0002-9149(95)80006-e.
The combination of aspirin and warfarin is likely to be more effective than either agent alone in the prevention of ischemic heart disease (IHD), but its practical value also crucially depends on a low incidence of serious bleeding. The occurrence of bleeding of different degrees of severity is being established in the Thrombosis Prevention Trial of primary prevention in men aged 45-69 years at increased risk of IHD, in which 75 mg aspirin and warfarin dosed to an international normalized ratio of 1.5 are used in a factorial design. The annual risk of serious bleeding, i.e., requiring transfusion or surgery, may be about 1 in 500 for those on active treatment, whether this consists of both aspirin and warfarin or either alone. Less serious degrees of bleeding are significantly increased by the combination of aspirin and warfarin compared with either alone and by either alone compared with placebo. The risk of serious bleeding is probably acceptable if low dosages are used.
阿司匹林与华法林联合使用在预防缺血性心脏病（IHD）方面可能比单独使用任何一种药物都更有效，但其实际价值也关键取决于严重出血的低发生率。在一项针对45 - 69岁IHD风险增加男性的一级预防血栓形成预防试验中，正在确定不同严重程度出血的发生率，该试验采用析因设计，使用75毫克阿司匹林和将华法林剂量调整至国际标准化比值为1.5。对于接受积极治疗的患者，即无论是同时服用阿司匹林和华法林还是单独服用其中一种，严重出血（即需要输血或手术）的年风险可能约为五百分之一。与单独使用阿司匹林或华法林相比，阿司匹林和华法林联合使用会使不太严重程度的出血显著增加，而单独使用阿司匹林或华法林与使用安慰剂相比也会使出血增加。如果使用低剂量，严重出血的风险可能是可以接受的。
