Combination anticoagulant and antiplatelet therapy in atrial fibrillation patients.

The question of whether or not combination antithrombotic therapy is beneficial in terms of a reduction in fatal and non-fatal vascular events in atrial fibrillation (AF) is an important question which essentially remains unanswered. Original randomised controlled trials in AF patients examining the efficacy of combination oral anticoagulant (OAC) and antiplatelet therapy for stroke prevention in AF, by comparing either fixed dose (or low intensity international normalized ratio, INR, <1.5) anticoagulation plus aspirin with dose-adjusted warfarin (INR, 2.0-3.0), or dose-adjusted warfarin ± aspirin, have not reported any additional benefit of fixed dose (or low intensity) anticoagulation plus aspirin over dose-adjusted warfarin alone. 1 The Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE)-W trial also showed that anticoagulation with dose-adjusted warfarin (INR, 2.0-3.0) was superior to the combination of clopidogrel plus aspirin for the prevention of vascular events in patients with AF at high risk of stroke, particularly in those