A meta-analysis from the Annals of Internal Medicine suggests that the benefits of the blood-thinner warfarin outweighs its risks of bleeding when used after a heart attack:

An analysis of 10 trials that included nearly 6,000 patients shows the combined treatment halved the risk of a second heart attack and stroke, said the report in Aug. 16 issue of the Annals of Internal Medicine.

"A lot more people can benefit from it [the dual therapy] than we realize," said study author Dr. Michael B. Rothberg, an associate professor of medicine at Tufts University School of Medicine in Boston.

There are several reasons why warfarin is underused, Rothberg said. "It hasn't been included in any of the guidelines," he said. "It's not on the radar screen for myocardial infarction [heart attack]. And warfarin is an inconvenient drug to manage, so physicians are reluctant to prescribe it in general."

The purpose of the paper "is to try to push warfarin back into the conversation," Rothberg said.

Currently, warfarin is not typically given after a heart attack. There are no conclusive studies suggesting a mortality improvement, and it can be a difficult drug to manage. This paper may push warfarin back into the picture, but more conclusive evidence is needed before this is widely adopted. (Edelson, "Blood-Thinner Warfarin Underused in Heart Attack Patients", Forbes, Aug.15; Rothberg et al., "Warfarin plus aspirin after Myocardial Infarction or the Acute Coronary Syndrome: Meta-Analysis with Estimates of Risk and Benefit", Annals of Int Med, Aug.16)