Dual antiplatelet therapy is not optimal for stroke prevention in patients with atrial fibrillation.
The superior efficacy of oral anticoagulation over aspirin for prevention of recurrent stroke in patients with atrial fibrillation is widely acknowledged. However, oral anticoagulation therapy is notorious for having a narrow therapeutic index, numerous drug and dietary interactions, and a significant risk of serious bleeding. The value of dual antiplatelet therapy for stroke prevention in patients with atrial fibrillation has been assessed in the ACTIVE A trial. In this study, the relative risk of primary events was significantly decreased in patients allocated clopidogrel and aspirin compared with patients receiving aspirin alone. However, the relative risk of major bleeding was also significantly increased. This article analyses critically the role of dual antiplatelet therapy for stroke prevention in patients with atrial fibrillation.
Chamorro
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Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain. achamorro@ub.edu
D001281:Atrial Fibrillation / Q000150:complications*; D004359:Drug Therapy, Combination; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors
D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K