Warfarin plus Aspirin after Myocardial Infarction or the Acute Coronary Syndrome: Meta-Analysis with Estimates of Risk and Benefit

1. 

   View larger version:

   • In this window
   • In a new window

   Figure 1. APRICOT-2 = Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis-2; ASPECT-2 = Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis-2; ATACS = Antithrombotic Therapy in Acute Coronary Syndromes; OASIS = Organization to Assess Strategies for Ischemic Syndromes; WARIS II = Warfarin, Aspirin, Reinfarction Study. Forest plot showing rate ratios of myocardial infarction for warfarin plus aspirin compared with aspirin alone.
2. 

   View larger version:

   • In this window
   • In a new window

   Figure 2. Studies with excluded rate ratios had no events in either group. ASPECT-2 = Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis-2; OASIS = Organization to Assess Strategies for Ischemic Syndromes; WARIS II = Warfarin, Aspirin, Reinfarction Study. Forest plot showing rate ratios of ischemic stroke for warfarin plus aspirin compared with aspirin alone.
3. 

   View larger version:

   • In this window
   • In a new window

   Figure 3. The study with an excluded rate ratio had no events in either group. APRICOT-2 = Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis-2; ASPECT-2 = Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis-2; ATACS = Antithrombotic Therapy in Acute Coronary Syndromes; OASIS = Organization to Assess Strategies for Ischemic Syndromes; WARIS II = Warfarin, Aspirin, Reinfarction Study. Forest plot showing rate ratios of death for warfarin plus aspirin compared with aspirin alone.
4. 

   View larger version:

   • In this window
   • In a new window

   Figure 4. The study with an excluded rate ratio had no events in either group. APRICOT-2 = Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis-2; ASPECT-2 = Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis-2; ATACS = Antithrombotic Therapy in Acute Coronary Syndromes; OASIS = Organization to Assess Strategies for Ischemic Syndromes; WARIS II = Warfarin, Aspirin, Reinfarction Study. Forest plot showing rate ratios of major bleeding for warfarin plus aspirin compared with aspirin alone.
5. 

   View larger version:

   • In this window
   • In a new window

   Figure 5. Numbers of cardiovascular events are the differences between the MI rates (aspirin rate − aspirin rate × risk ratio) plus the difference in stroke rates (baseline rates not shown) multiplied by 1000 patient-years. The number of bleeding episodes represents the difference in bleeding rates (combination rate − combination rate/risk ratio for major bleeding episode) multiplied by 1000. Letters and corresponding dots represent actual combinations of bleeding and cardiovascular risk from . The shaded area in the parallelogram represents unfavorable risk or benefit. APRICOT-2 = Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis-2; ASPECT-2 = Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis-2; ATACS = Antithrombotic Therapy in Acute Coronary Syndromes; OASIS = Organization to Assess Strategies for Ischemic Syndromes; WARIS II = Warfarin, Aspirin, Reinfarction Study. Predicted myocardial infarctions (MIs) and thrombotic strokes averted and excess bleeding episodes caused in 1000 patients as a result of adding warfarin to aspirin for 1 year, stratified by bleeding and MI risk.Table 2
6. 

   View larger version:

   • In this window
   • In a new window

   Appendix Figure 1. Process of study selection.
7. 

   View larger version:

   • In this window
   • In a new window

   Appendix Figure 2. The study with an excluded rate ratio had no events in either group. APRICOT-2 = Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis-2; ASPECT-2 = Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis-2; ATACS = Antithrombotic Therapy in Acute Coronary Syndromes; OASIS = Organization to Assess Strategies for Ischemic Syndromes; WARIS II = Warfarin, Aspirin, Reinfarction Study. Forest plot showing rate ratios of percutaneous transluminal coronary angioplasty or coronary artery bypass grafting for warfarin plus aspirin compared with aspirin alone.
8. 

   View larger version:

   • In this window
   • In a new window

   Appendix Figure 3. APRICOT-2 = Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis-2; ASPECT-2 = Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis-2; ATACS = Antithrombotic Therapy in Acute Coronary Syndromes; OASIS = Organization to Assess Strategies for Ischemic Syndromes; WARIS II = Warfarin, Aspirin, Reinfarction Study. Forest plot showing rate ratios of minor bleeding for warfarin plus aspirin compared with aspirin alone.