Document Detail


Risks and benefits of combining aspirin with anticoagulant therapy in patients with atrial fibrillation: an exploratory analysis of stroke prevention using an oral thrombin inhibitor in atrial fibrillation (SPORTIF) trials.
MedLine Citation:
PMID:  17070169     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Aspirin is used in combination with anticoagulant therapy in patients with atrial fibrillation (AF), but evidence of additional efficacy is not available. METHODS: We compared ischemic events and bleeding in the SPORTIF III and IV randomized trials of anticoagulation with warfarin (international normalized ratio 2-3) or fixed-dose ximelagatran. Low-dose aspirin (<100 mg/d) was allowed based on prevailing guidelines. RESULTS: The 14% of patients receiving aspirin more often had diabetes (27.5% vs 23%, P < .01), coronary artery disease (69% vs 41%, P < .01), previous stroke or transient ischemic attack (26% vs 20%, P < .01), and left ventricular dysfunction (41% vs 36%, P < .01). Addition of aspirin to either warfarin or ximelagatran was associated with no reduction in stroke or systemic embolism. Major bleeding occurred significantly more often with aspirin plus warfarin (3.9% per year) than with warfarin alone (2.3% per year, P < .01), aspirin plus ximelagatran (2.0% per year), or ximelagatran alone (1.9% per year). The rate of myocardial infarction with aspirin and warfarin (0.6% per year) was not significantly different from that with ximelagatran alone (1.0% per year), warfarin alone (1.0% per year), or aspirin and ximelagatran (1.4% per year). CONCLUSIONS: Aspirin combined with anticoagulant therapy was associated with no reduction in stroke, systemic embolism, or myocardial infarction in patients with AF. Aspirin combined with warfarin was associated with an incremental rate of major bleeding of 1.6% per year. No increased major bleeding occurred with aspirin and ximelagatran. These results suggest that the risks associated with addition of aspirin to anticoagulation in patients with AF outweigh the benefit.
Authors:
Greg C Flaker; Michael Gruber; Stuart J Connolly; Steven Goldman; Sandra Chaparro; Alec Vahanian; Matti O Halinen; Jay Horrow; Jonathan L Halperin;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  152     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-30     Completed Date:  2006-11-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  967-73     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, University of Missouri-Columbia, Columbia, MO, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / adverse effects,  therapeutic use*
Aspirin / adverse effects,  therapeutic use*
Atrial Fibrillation / drug therapy*
Azetidines / adverse effects,  therapeutic use
Benzylamines / adverse effects,  therapeutic use
Drug Therapy, Combination
Embolism / prevention & control
Female
Hemorrhage / chemically induced
Humans
Male
Middle Aged
Myocardial Infarction / prevention & control
Myocardial Ischemia / prevention & control
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use*
Randomized Controlled Trials as Topic
Risk Assessment
Stroke / prevention & control
Treatment Outcome
Warfarin / adverse effects,  therapeutic use
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Azetidines; 0/Benzylamines; 0/Platelet Aggregation Inhibitors; 0/ximelagatran; 50-78-2/Aspirin; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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