Peripheral Arterial Disease: Adding Warfarin to Antiplatelet Therapy Only Increases Bleeding Risk

Peripheral Arterial Disease: Adding Warfarin to Antiplatelet Therapy Only Increases Bleeding Risk

The addition of anticoagulants to antiplatelet therapy does not improve outcomes in peripheral arterial disease and significantly increases the risk for life-threatening bleeding, according to a study in the current New England Journal of Medicine.

In the international WAVE trial, researchers randomized some 2100 patients with peripheral arterial disease either to antiplatelet therapy alone or to combination therapy with anticoagulants. After 35 months of follow-up, there were no significant differences between the groups in MI, stroke, severe peripheral or coronary ischemia, or death from cardiovascular causes.

Life-threatening bleeding, and in fact bleeding of any severity, was significantly higher with combination therapy.

Writing in Journal Watch General Medicine, Allan S. Brett comments that although combination therapy in peripheral arterial disease is no longer in general use, "patients with PAD sometimes receive warfarin for other reasons and are continued on that drug even after the non-PAD indication disappears; this study strongly suggests that such patients would be better off taking aspirin alone."

LINKS:

NEJM article (Free abstract; full text requires subscription)

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Journal Watch General Medicine summary (Free)Journal Watch Cardiology summary (Free)