老年与中年急性冠脉综合征患者不同双联抗血小板方案疗效与出血风险比较

目的比较≥75岁老年急性冠脉综合征(ACS)患者与60岁中年ACS患者"阿司匹林+替格瑞洛"与"阿司匹林+氯吡格雷"两种双联抗血小板治疗(DAPT)方案的疗效与出血风险。方法连续入选2014年3月至2015年5月于解放军总医院心血管内科住院治疗的ACS患者、年龄60岁及≥75岁,并进行血栓弹力图(T7EG)检查的患者416例,分为:(1)年龄60岁阿司匹林+氯吡格雷(60C组),(2)年龄≥75岁阿司匹林+氯吡格雷(≥75C组),(3)年龄60岁阿司匹林+替格瑞洛(60T组),(4)年龄≥75岁阿司匹林+替格瑞洛(≥75T组),随访1年,比较各组主要不良心血管事件(MACE)及出血情况。结果各组MACE事件发生率、TEG检测的最大振幅(MA)值、花生四烯酸抑制率(AA-IPA)差异均无统计学意义(P0.05);相同年龄段"阿司匹林+替格瑞洛"患者二磷酸腺苷抑制率(ADP-IPA)高于"阿司匹林+氯吡格雷"(P0.05),但"阿司匹林+替格瑞洛"在两个年龄段的ADP-IPA差异无统计学意义(P=0.828),≥75C组ADP-IPA较60C组低(P=0.011);相同年龄段"阿司匹林+替格瑞洛"患者出血事件发生率高于"阿司匹林+氯吡格雷"患者(P0.05),但多为I型非致命性出血;"阿司匹林+替格瑞洛"在不同年龄段出血事件发生率差异无统计学意义(P=0.392)。应用Cox回归分析MACE危险因素:血糖(B=0.111,RR=1.117,95%CI:1.014~1.231,P=0.025),eGFR(B=-0.023,RR=0.977,95%CI:0.961~0.993,P=0.005),心率(B=0.040,RR=1.041,95%CI:1.013~1.070,P=0.004)。应用logistic回归分析出血事件危险因素:DAPT方案(B=3.527,OR=34.025,95%CI:9.560~121.101,P0.001),性别(B=1.126,OR=3.085,95%CI:1.083~8.788,P=0.035)。结论在本研究中"阿司匹林+替格瑞洛"的临床疗效不优于"阿司匹林+氯吡格雷",且I型出血风险增高;中、老年人口服"阿司匹林+替格瑞洛"的出血风险无差异。     

老年与非老年脑出血心电图分析

本文通过老年脑出血与非老年脑出血心电图的对比分析。以探讨老年与非老年脑出血心电图特点及评价其临床意义。现报道如下。1　资料与方法81例脑出血患者 ,统一按《临床疾病诊断依据治愈好转标准》做出诊断 ,并经头颅ＣＴ确诊。病史中均无心脏病病史。所有心电图均于住院后测定 ,各项指标组间比较作Ｘ2 检验。 81例病人按年龄分为老年组 (Ａ组 )和非老年组 (Ｂ组 )两组。Ａ组 41例 ,年龄 60～ 88岁 ,平均70 1岁 ,男 2 8例 ,女 13例。其中脑出血3 6例 ,蛛网膜下腔出血 5例 ;丘脑和基底节出血 3 0例 ,脑叶出血 5例 ,脑干出血 1例。Ｂ组 40例 …     

氯吡格雷联合阿司匹林治疗糖尿病并发急性脑梗死的临床研究

目的探讨氯吡格雷联合肠溶阿司匹林治疗糖尿病并发急性非心源性脑梗死的早期疗效和安全性。方法选择90例糖尿病并发首次非心源性急性脑梗死的患者,随机分为治疗组(45例)和对照组(45例)。治疗组给予氯吡格雷联合肠溶阿司匹林治疗,对照组给予肠溶阿司匹林治疗,分别在治疗前后进行临床疗效评定、神经功能缺损评分(NDS)及发生出血不良反应统计。结果在糖尿病并发急性非心源性脑梗死的早期治疗中,两组临床疗效比较和神经功能缺损评分比较有统计学意义(P0.05);两组均无发生脑出血,两组不良反应比较差异无统计学意义(P0.05)。结论氯吡格雷联合肠溶阿司匹林在糖尿病并发急性非心源性脑梗死的早期治疗中疗效显著,优于单用肠溶阿司匹林,且不良反应轻,出血发生率低,值得临床推广应用。     

太极拳运动对60~70岁老年人群步态的影响

目的探讨太极拳运动对60~70岁健康老年人群增龄性步态变化。方法步态分析的方法。结果健康成年人在61~65岁与66~70岁这两个年龄段上,步幅长度、左脚着地速度、步长与身高的比值、左膝关节在着地时的角度呈减小的趋势,两个年龄段之间存在显著性差异(P0.05)。步态周期、步频组间没有显著性差异(P0.05)。结论太极拳运动对增龄性步态变化的影响在61~65岁年龄段作用显著。     

急性脑卒中并发应激性溃疡危险因素分析

目的 分析急性脑卒中患者发生应激性溃疡的危险因素,指导临床更好地预防及治疗急性脑卒中并发应激性溃疡。方法采用回顾性分析的方法,建立《急性脑卒中后应激性溃疡的高危因素调查量表》,收集2200例急性脑卒中患者的住院病史,根据量表内容进行多因素分析。结果本研究最后有效病例2034例,并发应激性溃疡126例,发生率为6．21％。男性脑卒中并发应激性溃疡发生率明显高于女性,〉60岁患者脑卒中并发应激性溃疡发生率高于≤60岁患者,脑出血并发应激性溃疡发生率明显高于脑梗死和蛛网膜下腔出血,GCS评分5—3分患者脑卒中并发应激性溃疡发生率高于10-6分和15～11分患者,预防性使用阿司匹林〉90d患者脑卒中并发应激性溃疡发生率高于≤90d患者,差异均有统计学意义（P〈0．05）。主要影响脑卒中并发应激性溃疡的因素为：男性、年龄〉60岁、病变性质为脑出血、病变位于脑干或小脑、预防应用小剂量阿司匹林≤90d。结论急性脑卒中出现消化道出血临床症状的高危因素包括：年龄〉60岁、男性、0CS评分〈5分、病变位于脑干及小脑、高血压脑出血、病前曾使用小剂量阿司匹林预防用药。     

替罗非班可减少脑梗死静脉溶栓后进展性脑梗死的发生率

目的：探讨脑梗死静脉溶栓后早期使用替罗非班是否可减少进展性脑梗死的发生率。方法：选择140例脑梗死溶栓后低出血风险的患者，采用回顾性队列研究方法，51例静脉溶栓后使用替罗非班为暴露组，89例静脉溶栓后未使用替罗非班为非暴露组。比较2组进展性脑梗死发生率、早期症状改善率、症状性脑出血发生率及发病90d预后的差异。结果：暴露组进展性脑梗死发生率显著低于非暴露组（P=0.011），早期症状改善率明显高于非暴露组（P<0.001），2组患者出血转化率比较，差异无统计学意义（P=0.300），暴露组90d预后显著好于非暴露组（P=0.037）。结论：对于溶栓后低出血风险脑梗死患者，使用替罗非班可减少进展性脑梗死的发生率，能促进早期症状恢复并改善长期预后，不增加症状性脑出血发生率。     

华法林与阿司匹林在脑梗死伴非瓣膜性心房颤动患者二级预防中的有效性和安全性比较

目的比较华法林与阿司匹在脑梗死伴非瓣膜性心房颤动(房颤)患者二级预防中的有效性和安全性。方法选取2011年1月—2012年6月在焦作市第五人民医院接受治疗的脑梗死伴非瓣膜性房颤患者84例,采用随机数字表法分为对照组和观察组,每组42例。对照组患者给予阿司匹林,观察组患者给予华法林,严密监测国际标准化比值(INR)并及时调整华法林剂量。比较两组患者随访2年内预防效果和不良反应发生情况。结果观察组患者脑栓塞发生率低于对照组(P0.05);而两组患者脑出血发生率比较,差异无统计学意义(P0.05)。观察组患者不良反应发生率低于对照组(P0.05)。结论华法林能够有效预防非瓣膜性房颤患者出现脑梗死,在严密监测并控制INR条件下调整华法林剂量安全有效,不会增加脑出血发生率,且不良反应较少,用药安全性较高。     

合并脑微出血的脑梗死病人出血转化的风险性研究

目的探讨合并脑微出血(cerebral microbleed,CMB)的脑梗死病人急性期和恢复期出血转化的风险及可能原因。方法收集我院合并脑CMB的脑梗死病人160例(有CMB组),以及无CMB的脑梗死病人180例(无CMB组),通过比较2组急性期和恢复期出现脑出血的不同发生率,探讨CMB对脑梗死出血转化的影响。结果在脑梗死急性期病人中,2组出血的发生率差异无统计学意义(P0.05);而对于恢复期的病人,有CMB组病人出血的发生率较高(P0.05)。恢复期服用阿司匹林病人中,合并CMB病人脑出血的发生率明显高于无CMB组(16.3%比6.7%,P0.05)结论 CMB可增加脑梗死恢复期病人出血的发生率,尤其是那些服用阿司匹林的病人。CMB可能是一种逐渐进展的脑微血管病。     

高龄患者长期服用阿司匹林的安全性

目的探讨高龄患者服用阿司匹林的安全性。方法回顾性分析该院老年病科1989年1月至2013年12月775例高龄患者(年龄≥80岁)的阿司匹林使用情况,根据治疗分为阿司匹林组(100 mg/d)445例,非阿司匹林组330例,统计分析其疾病谱、服用阿司匹林的持续时间、消化道出血及脑出血的发生率、用药前后血小板计数变化的情况。结果 775例患者均以患心脑血管疾病为主。阿司匹林组平均服药年限为3.82年,最长服药年限24年,服药年限≥5年294例(66.07%)。两组出血事件及用药前后血小板计数比较差异无统计学意义(P0.05)。结论高龄患者在心脑血管疾病的二级预防中长期应用阿司匹林安全性较高。     

泉州市某医院老年人骨密度调查及其与体质量指数的关系

目的调查福建省泉州市某医院老年人骨密度及其与体质量指数的关系。方法选取2011年5月至2014年5月在福建省泉州市某医院就诊的800例老年人,采用双能X线骨密度仪测定其腰椎、左侧股骨颈、大粗隆及Ward's三角的骨密度,记录入选老年人群的身高、体质量及年龄,计算体质量指数并根据测定的骨密度统计各年龄段骨质疏松的发生率。结果不同部位骨密度在两性之间的差异有统计学意义(P0.01)。男性86~90岁、91~95岁年龄段左股骨颈、大粗隆、Ward's三角、L1、L3、L4及L1~4的骨密度与60~65岁年龄段比较,差异具有统计学意义(P0.05)。女性86~90岁、91~95岁年龄段左股骨颈、大粗隆、Ward's三角、L2、L3、L4及L1~4的骨密度与60~65岁年龄段比较,差异具有统计学意义(P0.05)。66~70岁、71~75岁、76~80岁、81~85岁、86~90岁,男性与女性骨质疏松发生率比较,差异均有统计学意义(P0.01或P0.05)。年龄与大粗隆、左股骨颈及Ward's三角骨密度呈负相关(P0.01)。体质量及体质量指数与大粗隆、左股骨颈、腰椎L1~L4、Ward's三角骨密度呈正相关(P0.01)。结论随着年龄增长,福建省泉州市老年人群骨质疏松发生率会逐渐升高,其中体质量及体质量指数是骨质疏松的保护因素。     

Cardiovascular risk prediction by N-terminal pro brain natriuretic peptide and high sensitivity C-reactive protein is affected by age and sex

BACKGROUND: Previous studies have shown that the urine albumin/creatinine ratio (UACR), high sensitivity C-reactive protein (hsCRP) and N-terminal pro brain natriuretic peptide (Nt-proBNP) predict cardiovascular events in a general population aged 41, 51, 61 or 71 years. This study investigated the impact of age and sex on their prognostic performance in a subgroup of 1994 apparently healthy individuals without diabetes, previous stroke or myocardial infarction, who did not receive any cardiovascular, antidiabetic or lipid-lowering medication. METHODS: In 1993-1994 we recorded cardiovascular risk factors, UACR, hsCRP and Nt-proBNP. The composite cardiovascular endpoint (CEP) of cardiovascular death and non-fatal stroke or myocardial infarction was assessed after 9.5 years. RESULTS: In Cox regression analyses predicting CEP, the effects of log(hsCRP) and log(Nt-proBNP) were modulated by sex (P < 0.05) and age (P < 0.05), respectively. The effect of logUACR was not significantly modulated by age or sex. Log(hsCRP)/SD did not predict CEP in women, but did predict CEP in 41 plus 51-year-old men [hazard ratio (HR) 1.71; 95% confidence interval, 1.1-2.6; P < 0.05] and 61 plus 71-year-old men (HR 1.64; 1.3-2.2; P < 0.001). Log(Nt-proBNP)/SD predicted CEP in 61 plus 71-year-old women (HR 1.74; 1.2-2.5; P < 0.01) and in 61 plus 71-year-old men (HR 1.58; 1.3-2.0; P < 0.001). CONCLUSION: Elevated hsCRP, reflecting early atherosclerosis, predicted CEP even in 41 plus 51-year-old men. Elevated Nt-proBNP, reflecting subclinical cardiovascular damage, predicted CEP in 61 plus 71-year-old subjects. Elevated UACR, reflecting endothelial dysfunction as well as microvascular damage, predicted events independently of age and sex, but primarily in 61 plus 71-year-old subjects.     

脑梗死后血小板CD62p表达的动态变化及抗血小板药物的影响

目的观察脑梗死急性期至恢复期CD62p的动态变化,并探讨抗血小板药物对其影响。方法选择急性脑梗死患者73例作为脑梗死组,并随机分为阿司匹林组(41例)和氯吡格雷组(32例)2个亚组分别进行治疗,同期选择年龄、性别相匹配的非脑血管病患者(高危对照组,20例)及健康体检者(健康对照组,20例),采用流式细胞技术,前2组于发病后<48 h、7、21、90天,另1组体检时对血小板CD62p表达进行检测,并作比较。结果与高危对照组及健康对照组比较,脑梗死组各时间点CD62p表达均显著增加(P<0.01);与<48 h比较,脑梗死组21天和90天时CD62p表达显著下降(P<0.01),但21天与90天比较差异无统计学意义(P>0.05)。90天时,氯吡格雷组CD62p表达显著低于阿司匹林组(P<0.05)。结论脑梗死急性期血小板活化增强,随时间延长,CD62p表达逐渐下降;氯吡格雷较阿司匹林具有更强的抑制CD62p表达作用。     

脑卒中后癫痫发作的临床特点和视频脑电图分析

目的分析脑卒中后继发癫痫的临床和视频脑电图特征。方法对102例脑卒中后癫痫患者的临床特点和视频脑电图特征进行回顾分析。结果脑出血、蛛网膜下腔出血患者癫痫发生率明显高于脑梗死(69.4%vs79.6%vs 35.3%,P<0.05)。早发型癫痫为68.6%,其中蛛网膜下腔出血以部分性发作继发全面性发作多见。迟发型癫痫为31.4%,其中脑梗死占64.7%,部分性发作占23.5%(P<0.05);病灶在脑叶皮质者癫痫的发生率为82.4%;102例患者出现脑电图特异性异常54例(52.9%)。结论脑卒中后以早发型癫痫多见,早发型癫痫以蛛网膜下腔出血多见,迟发型癫痫以脑梗死多见。病灶在脑叶皮质者癫痫发生率高。脑卒中后继发癫痫发作形式早期以部分性发作继发全面性发作多见,迟发型癫痫以部分性发作多见。脑电图出现周期性一侧癫痫样放电预后差。     

华法林与阿司匹林预防非瓣膜性心房颤动患者血栓栓塞的随机对照研究

目的通过前瞻性、随机、多中心研究比较阿司匹林与调整剂量华法林预防非瓣膜性心房颤动(房颤)患者发生血栓栓塞的有效性和安全性。方法在18个中心,根据入选标准将非瓣膜性房颤患者随机分配至阿司匹林组(150~160mg/d)和调整剂量华法林组(初始剂量2mg/d),目标国际标准化比值(INR)为2·0~3·0(年龄≥75岁者的INR为1·6~2·5)。常规门诊随访,调整华法林剂量并记录两组患者的终点事件和不良反应发生情况。主要终点事件为缺血性脑卒中和死亡,次要终点事件包括短暂性脑缺血发作、腔隙性脑梗死、外周动脉栓塞、急性心肌梗死和严重出血。结果共704例患者进入分析,阿司匹林组369例,华法林组335例。男性420例(59·7%),平均年龄(63·3±9·9)岁,两组患者基线特征(包括合并疾病和伴随用药)差异无统计学意义。随访时间中位数19个月(2~24个月)。与阿司匹林比较,调整剂量华法林明显降低主要终点事件发生率[2·7%比6·0%,P=0·03,OR0·44,95%可信区间(CI)为0·198~0·960],相对危险下降54%;缺血性脑卒中的相对危险下降62%(1·8%比4·6%,P=0·04,OR0·38,95%CI为0·147~0·977);总血栓栓塞事件相对危险下降52%(10·6%比5·4%,P=0·01,OR0·48,95%CI为0·269~0·858)。次要终点事件两组间差异无统计学意义。华法林组轻微出血和严重出血发生率均高于阿司匹林组(P<0·05)。华法林组总死亡率低于阿司匹林组[4例(1·2%)比8例(2·2%)],但差异无统计学意义(P>0·05);包括主要和次要终点的联合终点事件华法林组低于阿司匹林组(8·4%比13·0%,P=0·047)。结论与阿司匹林相比,华法林可明显降低国人非瓣膜性房颤患者脑卒中的发生率,华法林组出血的发生率高于阿司匹林组,但多数出血并发症发生在INR>3·0。严密监测(INR2·0~3·0)下的调整剂量华法林安全有效。     

他汀药对颈动脉粥样硬化影响及其在预防脑梗死复发中作用

目的探讨辛伐他汀对颈动脉粥样硬化的影响,以及其在预防脑梗死患者复发中的作用。方法将622例脑梗死患者分成阿司匹林治疗组与辛伐他汀治疗组,辛伐他汀治疗组在阿司匹林治疗的基础上加用辛伐他汀20mg,每晚1次。随访观察6~36月,观察脑梗死复发情况,并在治疗前及治疗后8~12周应用彩色多普勒超声对脑梗死患者的颈内动脉斑块和狭窄程度进行评估。结果根据随机分组,治疗前两组一般情况和脑梗死复发危险因素无差异(P>0.05),312例阿司匹林组患者在随访期复发61例(19.6%),而辛伐他汀组仅有32例(10.3%)复发,两组在统计学上有差异(P<0.05),在治疗前两组患者在颈内动脉粥样硬化程度、狭窄程度及斑块的超声病理分型等方面的比较,均无差异,治疗后辛伐他汀组颈动脉粥样硬化程度、狭窄程度以及软斑和溃疡斑块的发生率则明显降低,与治疗前比较有差异(P<0.05)。结论阿司匹林治疗的基础上加用辛伐他汀治疗能明显降低脑梗死复发率,辛伐他汀可能通过对颈动脉粥样硬化的影响而起到降低脑梗死复发的作用。     

急性脑梗死患者合并脑微出血的心脑血管事件发生的研究

目的研究急性脑梗死合并脑微出血(CMB)患者后期心脑血管事件的发生率和危险因素。方法将109例急性脑梗死患者分为CMB组38例和无CMB组71例,对其进行前瞻性研究,给予梯度回波T_2~*WI或磁敏感加权成像,并对患者的临床资料和影像学特点进行分析。平均随访(9.5±3.7)个月。结果与无CMB组比较,CMB组脑梗死和脑出血两者兼有,单纯脑出血比例明显升高(7.9%vs 1.4%,P<0.05;10.5%vs 0,P<0.01)。CMB组共检出CMB 153个。在随访中,1 6例患者再发脑卒中,包括11例脑梗死,5例脑出血。5例脑出血患者中有3例服用阿司匹林,2例接受抗凝治疗。CMB组有2例脑出血患者的出血部位与CMB部位相同。结论 CMB是脑微小血管病变特征之一;是急性缺血性脑血管病患者后期发生脑出血的危险因素之一;CMB对脑卒中患者长期服用阿司匹林或者抗凝治疗具有重要意义。     

Cilostazol in secondary prevention of stroke: impact of the Cilostazol Stroke Prevention Study

According to recent epidemiological data in Japan, stroke affects roughly 5.3 males and 3.9 females per 1000 person-years and is the third leading cause of mortality. At present, management strategies for secondary prevention of stroke include aggressive treatment of cardiovascular risk factors (i.e., hypertension, smoking cessation, etc.). Antiplatelet drugs in Japan, namely aspirin and cilostazol, are utilized regularly for the prevention of secondary stroke. While aspirin is beneficial for a wide range of cardiovascular endpoints, including total and ischemic strokes, it is also associated with significantly increased risks for hemorrhagic infarction. Cilostazol, by contrast, has been shown to significantly reduce the risk of recurrent strokes without affecting the occurrence of intracranial hemorrhage. In the Cilostazol Stroke Prevention Study, a randomized double-blind, placebo-controlled trial involving more than 1000 Japanese patients, cilostazol was found to reduce the risk of secondary stroke by 41.7% compared with placebo, a statistically significant reduction (P = 0.015). The greatest risk reduction (43.4% in cilostazol versus placebo, P = 0.0373) was found in patients who initially had a lacunar infarction, suggesting that cilostazol has a specific effect against small-vessel disease. In addition, cilostazol achieved significant risk reductions on a number of combined endpoints (e.g., cerebral infarction, intracranial hemorrhage, myocardial infarction, or vascular death), and was associated with benefits in intent-to-treat analyses. These findings indicate that cilostazol may have a role as a vascular neuroprotectant, but the clinical implications are limited by the fact that patients were randomized to placebo instead of aspirin, which is the standard of care.     

The effects of antiplatelet agents on platelet–leukocyte aggregations in patients with acute cerebral infarction

Background Studies have shown that platelet-leukocyte aggregates (PLA) are sensitive to platelet activation which might exist before the onset of cerebral infarction. In this study, we investigated the formation of PLA in patients with cerebral infarction and the effects of antiplatelet agents on PLA. Methods The level of soluble P-selectin, C-reaction protein, platelet aggregation rate and leukocyte-platelet aggregations were measured in 40 patients with acute cerebral infarction and 20 normal controls. The 40 patients were randomly assigned to two treatment groups: aspirin group (n = 20) and clopidogrel group (n = 20). Both groups were monitored for Scandinavian stroke scale (SNSS), soluble P-selectin, serum C-reaction protein, platelet aggregation rate and PLA before and after the treatment. Flow cytometry was used to detect the levels of PLA in the blood. Results The percentage of platelet-monocyte aggregates (PMA) in patients with cerebral infarction was significantly increased compared with the controls (P < 0.001), which was positively correlated to soluble P-selectin, C-reaction protein and platelet aggregation rate (P < 0.05). After the treatment, the levels of PMA and platelet aggregation rate were decreased in both groups (P < 0.05). The level of PMA and platelet aggregation rate in the clopidogrel group was significantly lower than that in the aspirin group (P < 0.05). Conclusions PMA are a sensitive biomarker to platelet activation in patients with cerebral infarction. In addition, although both aspirin and clopidogrel lowered the level of PMA, clopidogrel is a more effective treatment than aspirin in inhibiting platelet activation.     

Department of Veterans Affairs Cooperative Studies Program Clinical Trial comparing combined warfarin and aspirin with aspirin alone in survivors of acute myocardial infarction: primary results of the CHAMP study

BACKGROUND: Both aspirin and warfarin when used alone are effective in the secondary prevention of vascular events and death after acute myocardial infarction. We tested the hypothesis that aspirin and warfarin therapy, when combined, would be more effective than aspirin monotherapy. Methods and Results- We conducted a randomized open-label study to compare the efficacy of warfarin (target international normalized ratio 1.5 to 2.5 IU) plus aspirin (81 mg daily) with the efficacy of aspirin monotherapy (162 mg daily) in reducing the total mortality in 5059 patients enrolled within 14 days of infarction and followed for a median of 2.7 years. Secondary end points included recurrent myocardial infarction, stroke, and major hemorrhage. Four hundred thirty-eight (17.3%) of 2537 patients assigned to the aspirin group and 444 (17.6%) of 2522 patients assigned to the combination group died (log-rank P=0.76). Recurrent myocardial infarction occurred in 333 patients (13.1%) taking aspirin and in 336 patients (13.3%) taking combination therapy (log-rank P=0.78). Stroke occurred in 89 patients (3.5%) taking aspirin and in 79 patients (3.1%) taking combination therapy (log-rank P=0.52). Major bleeding occurred more frequently in the combination therapy group than in the aspirin group (1.28 versus 0.72 events per 100 person years of follow-up, respectively; P<0.001). There were 14 individuals with intracranial bleeds in both the aspirin and combination therapy groups. CONCLUSIONS: In post-myocardial infarction patients, warfarin therapy (at a mean international normalized ratio of 1.8) combined with low-dose aspirin did not provide a clinical benefit beyond that achievable with aspirin monotherapy.