Superiority of warfarin over aspirin long term after thrombolytic therapy for acute myocardial infarction.

Results of recent clinical trials have unequivocally established the value of intravenous thrombolytic therapy in enhancing survival after acute myocardial infarction. However, the optimum long-term antithrombolytic strategy for prevention of recurrent cardiac complications after thrombolysis is unknown at the current time. To determine whether aspirin or warfarin best prevents postdischarge recurrent cardiac events (unstable angina, reinfarction, pulmonary edema, or/and death), we analyzed the long-term course of 203 patients at our institution who received intravenous thrombolytic therapy (streptokinase, tissue plasminogen activator, or urokinase) for acute myocardial infarction. Of these, 129 (64%) survived to hospital discharge without revascularization--92 patients (71%) received aspirin (325 mg/day). whereas 37 (29%) received warfarin. The choice of drug was made by the treating physician. By a mean of 2.5 years of follow-up, 34 of 92 patients receiving aspirin (37%) versus 6 or 37 receiving warfarin (16%) (p less than or equal to 0.02) had unstable angina, reinfarction, pulmonary edema, and/or death. No life-threatening hemorrhage occurred in either group. Warfarin appears to be superior to aspirin long term in patients with postlysis myocardial infarction for the prevention of recurrent cardiac complications.