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ADDING HEPARIN TO ASPIRIN OF LITTLE BENEFIT IN ACUTE MI.

Although the benefits of aspirin during the acute phase of myocardial infarction are known, the role of heparin remains uncertain. This meta-analysis of randomized trials suggests that little additional benefit is gained by adding heparin to aspirin for acute MI.

Researchers identified 21 trials involving 5000 patients that compared heparin with no antithrombotic therapy and six trials involving 68,000 patients that compared heparin plus aspirin with aspirin alone.

Heparin in the absence of aspirin reduced mortality when compared with no antithrombotic therapy (11.4 vs. 14.9 percent), representing 35 fewer deaths per 1000 patients, 10 fewer strokes per 1000, 19 fewer pulmonary emboli per 1000, with 13 extra major bleeds per 1000 patients. The type of heparin regimen used did not affect outcome.

Heparin plus aspirin reduced mortality minimally when compared with aspirin alone (8.6 vs. 9.1 percent), resulting in only 5 fewer deaths per 1000 patients, 3 fewer reinfarctions per 1000, 1 pulmonary emboli per 1000, with 3 more major bleeds per 1000.

Comment: This analysis does not justify the addition of heparin to the now routine use of aspirin for acute MI. It suggests that heparin adds minimal benefit and a small risk.

— KI Marton

Published in Journal Watch General Medicine October 22, 1996

Citation(s):

Collins R et al. Clinical effects of anticoagulant therapy in suspected acute myocardial infarction: systematic overview of randomised trials. BMJ 1996 Sep 14 313 652-659.

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