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Coumadin aspirin reinfarction study: Rationale and design of the CARS study

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Abstract

Acute myocardial infarction remains the leading cause of death in the United States. Following increased recognition of the role of thrombosis in the pathogenesis of myocardial infarction, both antiplatelet and anticoagulant therapy have been proven effective in preventing recurrent infarction. However, the optimal antithrombotic regimen remains undetermined. In particular, the role of combination antithrombotic therapy has not been studied. The Coumadin Aspirin Reinfarction Study (CARS) will compare the safety and efficacy of fixed-dose combination Coumadin plus aspirin versus aspirin alone among 8000 survivors of acute myocardial infarction. Patients will be followed for up to 4 years. CARS will provide important information regarding the optimal antithrombotic regimen for myocardial infarct survivors.

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References

  1. American Heart Association.1992 Heart and Stroke Facts. Dallas, TX: American Heart Association, 1992.

    Google Scholar 

  2. Cairns JA, Hirsch J, Lewis HD Jr, Resnekov L, Theroux P. Antithrombin agents in coronary artery disease.Chest 1989;95(Suppl):456S-481S.

    Google Scholar 

  3. von Rokitanski K.A Manual of Pathological Anatomy (translated from German by GE Day). London: Sydenham Society, 1852, Vol 4, p 261.

    Google Scholar 

  4. Davies MJ, Bland MJ, Hangartner WR, et al. Factors influencing the presence or absence of acute coronary thrombi in sudden ischemic death.Eur Heart J 1989;10:203–208.

    PubMed  Google Scholar 

  5. Fuster V, Badimon L, Badimon JJ, Chesebro J. Coronary artery disease progression and acute coronary syndromes.N Engl J Med 1992;326:242–250.

    PubMed  Google Scholar 

  6. Fuster V. Mechanisms leading to myocardial infarction: Insights from studies of vascular biology.Circulation 1994;90:2126–2146.

    PubMed  Google Scholar 

  7. Badimon L, Lassila R, Badimon J, Fuster V. An acute surge of epinephrine stimulates platelet deposition to severely damaged vascular wall [abstract].J Am Coll Cardiol 1990;15(Suppl):181A.

    Google Scholar 

  8. Meade TW, Imeson J, Stirling Y. Effects of changes in smoking and other characteristics on clotting factors and the risk of ischemic heart disease.Lancet 1987;2:986.

    PubMed  Google Scholar 

  9. Kimura S, Nishinaga M, Ozawa T, Shimada K. Thrombin generation as an acute effect of cigarette smoking.Am Heart J 1994;128:7–11.

    PubMed  Google Scholar 

  10. Killam AI. Cardiovascular and thrombosis pathology associated with cocaine use.Hematol Oncol Clin North Am 1993;7:1143.

    PubMed  Google Scholar 

  11. Wilhelmsen L, Svaardsudd K, Korsan-Bengsten K, Larsson B, Welin L, Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction.N Engl J Med 1984;311:501–505.

    PubMed  Google Scholar 

  12. Meade TW, Mellows S, Brozovic M, et al. Haemostatic function and ischemie heart disease: Principal results of the Northwick Park Heart Study.Lancet 1986;2:533–537.

    PubMed  Google Scholar 

  13. Hamsten A, de Faire U, Walldius G, et al. Plasminogen activator inhibitor in plasma: Risk factor for recurrent myocardial infarction.Lancet 1987;2:3–9.

    PubMed  Google Scholar 

  14. Aspirin as a therapeutic agent in cardiovascular disease. AHA medical/scientific statement.Circulation 1993;87: 659–675.

    Google Scholar 

  15. Elwood PC, Cochrane AL, Burr ML, et al. A randomized controlled trial of acetyl salicylic acid in the secondary prevention of mortality from myocardial infarction.Br Med J 1974;1:436–440.

    PubMed  Google Scholar 

  16. The Coronary Drug Project Research Group. Aspirin in coronary heart disease.Circulation 1980;62(Suppl V):V59-V62.

    Google Scholar 

  17. Elwood PC, Sweetnam PM. Aspirin and secondary mortality after myocardial infarction.Circulation 1980;62(Suppl V):V53-V58.

    PubMed  Google Scholar 

  18. Breddin K, Loew D, Lechner K, Oberla K, Wlater E. The German-Austrian Aspirin Trial: A comparison of acetylsalicylic acid, placebo and phenprocoumon in secondary prevention of myocardial infarction.Circulation 1980;62(Suppl V):V3-V72.

    PubMed  Google Scholar 

  19. The Aspirin Myocardial Infarction Study Research Group. The Aspirin Myocardial Infarction Study: Final results.Circulation 1980;62(Suppl V):V79-V84.

    Google Scholar 

  20. The Persantine-Aspirin Reinfarction Study Research Group. Persantine and aspirin in coronary heart disease.Circulation 1980;62:449–461.

    Google Scholar 

  21. Klimt CR, Knatterud GL, Stamler J, Meier P. Persantine-aspirin study. II. Secondary coronary prevention with persantine and aspirin.J Am Coll Cardiol 1986;7:251–269.

    PubMed  Google Scholar 

  22. Aspirin after myocardial infarction. Editorial.Lancet 1980; 1:1172–1173.

    Google Scholar 

  23. Antiplatelet Trialists' Collaboration. Secondary prevention of vascular disease by prolonged aspirin treatment.Br Med J 1988;296:320–331.

    Google Scholar 

  24. Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet therapy-I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients.Br Med J 1994;308:81–106.

    Google Scholar 

  25. Cairns JA, Hirsh J, Lewis HD Jr, Resnekov L, Theroux P. Antithrombotic agents in coronary artery disease.Chest 1992;102(Suppl):456S-481S.

    PubMed  Google Scholar 

  26. Ebert RV, Borden CV, Hipp HR, et al. Long-term anticoagulant therapy after myocardial infarction: Final report of the Veteran's Administration Cooperative Study.JAMA 1969;207:2263–2267.

    PubMed  Google Scholar 

  27. Second Report of the Working Party on Anticoagulant Therapy in Coronary Thrombosis to the Medical Research Council. An assessment of long-term anticoagulant administration after cardiac infarction.Br Med J 1964;2:837–843.

    Google Scholar 

  28. Chalmers TC, Matta RJ, Smith H, Kunzler AM. Evidence favoring the use of anticoagulants in the hospital phase of acute myocardial infarction.N Engl J Med 1977;297:1091–1096.

    PubMed  Google Scholar 

  29. Report of the Sixty Plus Reinfarction Study Research Group. A double-blind trial to assess long-term oral anticoagulant therapy in elderly patients after myocardial infarction.Lancet 1980;2:989–993.

    Google Scholar 

  30. Smith P, Arnesen H, Holme I. The effect of warfarin on mortality and reinfarction after myocardial infarction.N Engl J Med 1990;323:147–152.

    PubMed  Google Scholar 

  31. Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis (ASPECT) Research Group. Effect of long-term oral anticoagulant treatment on mortality and cardiovascular morbidity after myocardial infarction.Lancet 1994;343:499–503.

    Google Scholar 

  32. Merlini PA, Bauer KA, Oltrona L, et al. Persistent activation of coagulation mechanism in unstable angina and myocardial infarction.Circulation 1994;90:61–68.

    PubMed  Google Scholar 

  33. Lam JYT, Latour JG, Lesperance J, Waters D. Platelet aggregation, coronary artery disease progression and future coronary events.Am J Cardiol 1994;73:333–338.

    PubMed  Google Scholar 

  34. Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction; ISIS-2.Lancet 1988;2:350–360.

    Google Scholar 

  35. Cohen M, Adams P, Parry G, et al. Combination antithrombotic therapy in unstable rest angina and non-Q wave infarction in nonprior aspirin users: Primary end points analysis from the ATACS trial.Circulation 1994;89:81–88.

    PubMed  Google Scholar 

  36. Turpie AGG, Gent M, Laupacis A, et al. A comparison of aspirin with placebo in patients treated with warfarin after heart valve replacement.N Engl J Med 1993;329:524–529.

    PubMed  Google Scholar 

  37. Meade TW, Roderick PJ, Brennan PJ, Wilkes HC, Kelleher CC. Extra-cranial bleeding and other symptoms due to low dose aspirin and low intensity oral anticoagulation.Thromb Haemost 1992;68:l-6.

    Google Scholar 

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Vorchheimer, D.A., Fuster, V. Coumadin aspirin reinfarction study: Rationale and design of the CARS study. J Thromb Thrombol 2, 171–176 (1995). https://doi.org/10.1007/BF01062707

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