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Antiplatelet agents are a cornerstone of therapy for patients with coronary artery disease (CAD). However, when a patient with stable CAD develops an indication for a second antithrombotic agent — e.g., warfarin for atrial fibrillation — bleeding risk increases if both agents are given. A prospective French study sheds some light on this common dilemma.
Among 4184 patients with stable CAD (no myocardial infarction [MI] or revascularization for >1 year), 51 patients had experienced major bleeding events at 2 years (0.6%/year); 12 events were fatal. Major bleeding was associated significantly with excess mortality (adjusted hazard ratio, 2.89). In multivariate analysis, use of vitamin K antagonists was one of several factors associated with ex…