The modest impact of antiplatelet agents on stroke chance may perhaps be extra attributable to the inhibition of platelet thrombi within the carotid and cerebral arteries than the inhibition of cardiogenic thrombi that arise in AF.26 Having said that, its most likely the reduced bleeding possibility with antiplatelet agents compared with that of VKAs stays their primary attraction. Are combination therapies a viable alternate to vitamin K antagonist or antiplatelet monotherapy in atrial fibrillation? Dual-antiplatelet therapy In earlier years, the relative efficacy and safety profiles of dualantiplatelet therapy happen to be assessed in patients with AF . Within the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Occasions W research, patients Vandetanib Zactima selleck with electrocardiogram-confirmed AF and a minimum of 1 threat aspect for stroke have been randomized to obtain clopidogrel with ASA or VKA treatment .27 Clopidogrel plus ASA treatment was connected with considerably extra big vascular events than VKA treatment . Costs of key bleeding had been comparable concerning the two groups, but there have been significantly far more cases of minor bleeding in the clopidogrel plus ASA group . The study was stopped early owing on the clear superiority of VKA therapy.
Acetylsalicylic acid is prescribed in individuals with AF who can’t tolerate VKAs.28 The Lively A trial in contrast the efficacy and safety of clopidogrel plus ASA vs. placebo plus ASA in individuals with AF jak2 inhibitors who have been at increased possibility of stroke, but who were deemed unsuitable for VKA treatment .28 During the clopidogrel plus ASA group, there have been significantly fewer main vascular events in contrast with the placebo plus ASA group . This impact for the main endpoint was mainly attributable to the lowered incidence of stroke. Having said that, important bleeding occurred extra usually in individuals taking clopidogrel than these obtaining placebo , with the most common web site of bleeding currently being the gastrointestinal tract. Clopidogrel plus ASA enhanced the chance of big extracranial bleeding by 51% and the danger of significant intracranial bleeding by 87%. There was no vital big difference in net clinical advantage between the 2 groups. Antiplatelet plus vitamin K antagonist treatment Scientific studies combining VKAs with antiplatelet therapy in individuals with AF have also been carried out. Their key aim was to assess regardless of whether blend therapy enabled the intensity of anticoagulation to be lowered, lessening the likelihood of extreme bleeding as well as the will need for regular monitoring, when keeping protective efficacy . The SPAF III trial in contrast ASA and fixed-dose warfarin with adjusted-dose warfarin alone in sufferers with non-valvular AF at substantial danger of thromboembolism.29 The trial was stopped early, owing to a drastically greater rate of ischaemic stroke and systemic embolism in the combination group in contrast with warfarin alone .