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Warfarin, in combination with aspirin or given alone, was superior to aspirin alone in reducing the incidence of composite events after an acute myocardial infarction but was associated with a higher risk of bleeding.

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The aim of this study was to assess the influence of aspirin on selected inflammatory markers in patients recovering from acute myocardial infarction (AMI). Patients participating in the Warfarin Aspirin Re-Infarction Study-II were randomized to either aspirin 160 mg/day or aspirin 75 mg/day + warfarin, or warfarin alone after AMI. After AMI, aspirin 160 mg/day was associated with significantly lower levels of high-sensitivity C-reactive protein and tumor necrosis factor-alpha than warfarin alone over 4 years. However, the same levels were not predictors for clinical end points.

Platelet aggregate ratio (PAR) was measured according to the method of Wu & Hoak in 143 patients after acute myocardial infarction (AMI) and in 54 controls. A PAR < 1 expresses the presence of platelet aggregates. The patients were randomized to aspirin 160 mg/d, or warfarin, or aspirin 75 mg/d + warfarin. In patients on aspirin, PAR was measured 24 h after aspirin intake, and in 76 patients also 2 h after aspirin. The median PAR in patients on warfarin was 0.85, on warfarin + aspirin 0.91 and on aspirin alone 0.94, all significantly lower than the median PAR of 0.97 in the controls. In 14 patients on aspirin the PARs were below a cut-off point of 0.82 (secondary aspirin non-responders). PAR increase significantly 2 h after aspirin intake. In two patients, however, PAR remained low (primary aspirin non-responders). It is concluded that some patients do not seem to respond to aspirin, the clinical implication of which has yet to be determined.

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