NICE guidance - warfarin (vitamin K antagonists) post myocardial infarction (MI)
Last reviewed 01/2018
NICE have issued guidance as to the use of vitamin K antagonists post myocardial infarction (1):
- high-intensity warfarin (INR >3) should not be considered as an alternative to aspirin in first-line treatment, for patients who have had an MI
- for patients who have had an MI and are unable to tolerate either
aspirin or clopidogrel
- treatment with moderate-intensity warfarin (INR 2-3) should be considered for up to 4 years, and possibly longer
- for patients who have had an acute MI, are intolerant to clopidogrel and have a low risk of bleeding, treatment with aspirin and moderate-intensity warfarin (INR 2-3) combined should be considered
- for patients already being treated
for another indication (mechanical valve, recurrent deep vein thrombosis, atrial
fibrillation, left ventricular thrombus), warfarin should be continued
- if a patient is being treated with moderate-intensity warfarin (INR 2-3) and who is at low risk of bleeding, then the addition of aspirin should be considered
- combination treatment with warfarin and clopidogrel is not routinely recommended
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