The modest result of antiplatelet agents on stroke chance may be much more thanks to the inhibition of platelet thrombi during the carotid and cerebral arteries compared to the inhibition of cardiogenic thrombi that arise in AF.26 Nevertheless, it really is very likely that the reduce bleeding risk with antiplatelet agents in contrast with that of VKAs stays their key attraction. Are blend therapies a viable alternate to vitamin K antagonist or antiplatelet monotherapy in atrial fibrillation? Dual-antiplatelet treatment In previous years, the relative efficacy and safety profiles of dualantiplatelet therapy have already been assessed in individuals with AF . Inside the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Occasions W review, sufferers Wortmannin 19545-26-7 with electrocardiogram-confirmed AF and at the very least 1 threat factor for stroke had been randomized to receive clopidogrel with ASA or VKA treatment .27 Clopidogrel plus ASA therapy was related with drastically even more big vascular events than VKA therapy . Rates of major bleeding were very similar involving the 2 groups, but there were significantly extra cases of minor bleeding in the clopidogrel plus ASA group . The study was stopped early owing for the clear superiority of VKA therapy.
Acetylsalicylic acid is prescribed in individuals with AF who can’t tolerate VKAs.28 The Active A trial compared the efficacy and safety of clopidogrel plus ASA vs. placebo plus ASA in patients with AF PF 477736 selleck chemicals who were at elevated threat of stroke, but who were regarded as unsuitable for VKA treatment .28 From the clopidogrel plus ASA group, there were drastically fewer leading vascular events in contrast with the placebo plus ASA group . This result for the major endpoint was mainly because of the reduced incidence of stroke. Even so, main bleeding occurred even more frequently in individuals taking clopidogrel than people obtaining placebo , together with the most typical web site of bleeding staying the gastrointestinal tract. Clopidogrel plus ASA enhanced the possibility of major extracranial bleeding by 51% as well as threat of leading intracranial bleeding by 87%. There was no substantial big difference in net clinical advantage concerning the 2 groups. Antiplatelet plus vitamin K antagonist therapy Research combining VKAs with antiplatelet therapy in individuals with AF have also been performed. Their primary aim was to assess whether combination treatment enabled the intensity of anticoagulation to be reduced, lessening the likelihood of excessive bleeding as well as the want for ordinary monitoring, while retaining protective efficacy . The SPAF III trial in contrast ASA and fixed-dose warfarin with adjusted-dose warfarin alone in patients with non-valvular AF at higher chance of thromboembolism.29 The trial was stopped early, owing to a considerably greater charge of ischaemic stroke and systemic embolism during the combination group compared with warfarin alone .