Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Is Adding Aspirin to Warfarin Therapy Beneficial?

JAMA Intern Med; ePub 2019 Mar 4; Schaefer, et al

Some patients receiving anticoagulation treatment with warfarin may be receiving concomitant aspirin therapy that may increase bleeding risk with unclear therapeutic benefit, a new study found. The registry-based cohort study included adults enrolled at 6 anticoagulation clinics in Michigan who were receiving warfarin therapy for atrial fibrillation (AF) or venous thromboembolism (VTE) without documentation of a recent myocardial infarction (MI) or history of valve replacement. Primary outcomes included rates of bleeding, major bleeding events, emergency department (ED) visits, hospitalizations, and thrombotic events at 1, 2, and 3 years. Among the details:

  • Of the study cohort of 6,539 patients (50.9% men, mean age 66.1 years), 2,453 patients (37.5%) without a clear therapeutic indication for aspirin were receiving combination warfarin and aspirin therapy.
  • At year 1, patients receiving combination warfarin and aspirin compared to those receiving warfarin only had higher rates of overall bleeding, major bleeding, ED visits for bleeding, and hospitalizations for bleeding.
  • Rates of thrombosis were similar.
  • Similar findings persisted during 3 years of follow-up and in sensitivity analyses.


Schaefer JK, Li Y, Gu X, et al. Association of adding aspirin to warfarin therapy without an apparent indication with bleeding and other adverse events. [Published online ahead of print March 4, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.7816.

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