Stroke, Vol 16, 668-675, Copyright © 1985 by American Heart Association
A Miller and RS Lees
Twenty of approximately 1000 patients attending the arteriosclerosis clinic
at MIT during a 13 year period were treated simultaneously with aspirin and
warfarin for symptomatic atherosclerotic (19) or rheumatic (1) heart or
vascular disease. The average duration of therapy was 5.8 years. Thirteen
patients suffered from familial hyperlipoproteinemia; only one patient had
none of the major risk factors for arteriosclerosis. Refractory symptoms
were related to the central nervous system in 13, peripheral vascular
system in 5 and the heart in 2. All twenty patients became asymptomatic or
showed marked clinical improvement on aspirin plus warfarin therapy. While
on this therapy, complications, both thrombotic and hemorrhagic, occurred
in 7 of the 20 patients (graft embolus in 1, and bleeding in 6; with one
death as a result of intracranial bleeding) and sudden death, probably from
acute myocardial ischemia, in a further 2 patients. We conclude that when
alternative therapies are impossible or have proven to be of no avail in
patients suffering from the complications of advanced atherosclerosis, the
simultaneous administration of aspirin and warfarin may be a therapeutic
alternative, although very close and careful followup of the patients'
prothrombin times and clinical status is essential.
ARTICLES
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