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Previous trial findings have shown that a vitamin K antagonist, such as warfarin, is superior to aspirin for reducing stroke incidence in individuals with atrial fibrillation who are at highest risk for stroke. However warfarin is associated with increased bleeding, has a narrow therapeutic window, and requires frequent blood draws for INR monitoring. To explore whether combining antiplatelet agents improves their efficacy compared with each agent alone, investigators for the industry-sponsored ACTIVE A trial randomized 7554 patients with AF to receive aspirin plus either clopidogrel or placebo. All participants had at least one additional risk factor for stroke and were considered poor candidates for warfarin.
During a median follow-up of 3…