Antiplatelet Therapy for Atrial Fibrillation: One Drug or Two?

In an ACTIVE substudy, the net clinical benefit of adding clopidogrel to aspirin in patients who were not candidates for warfarin was small and statistically nonsignificant.

In the ACTIVE W trial, warfarin was clearly superior to dual antiplatelet therapy (DAT: aspirin plus clopidogrel) for the prevention of ischemic events in patients with atrial fibrillation (AF; JW Cardiol Jul 19 2006). In the ACTIVE A trial involving patients who were unsuitable for warfarin therapy, the advantages of DAT over aspirin alone were ambiguous (JW Cardiol Mar 31 2009). To quantify the net clinical benefit of DAT in the ACTIVE A population, the ACTIVE investigators assigned weights to ischemic and hemorrhagic events by hazard ratio (HR) for death and by a composite measure of risk for death or disability.

Compared with ischemic stroke, the HR for death after hemorrhagic stroke was three times higher, and the HR for death after sub…

Reviewing Author

Joel M. Gore, MD

Disclosures

Grant/Research SupportNIH–National Heart, Lung, and Blood Institute

Joel M. Gore, MD

Disclosures

Grant/Research SupportNIH–National Heart, Lung, and Blood Institute

Antiplatelet Therapy for Atrial Fibrillation: One Drug or Two?

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Reviewing Author