October 20, 2004
Madrid, Spain –
Combination antiplatelet and anticoagulant therapy proves to
be more effective than either therapy alone in patients with
valvular and nonvalvular atrial fibrillation. A randomized
multicenter trial in 1,209 patients with chronic or paroxysmal
atrial fibrillation was published in the October 19, 2004
issue of the Journal of the American College of Cardiology by
Francisco Perez-Gomez, et al., from Madrid, Spain. This study
compared the therapeutic effects of the cyclooxygenase
inhibitor triflusal and the anticoagulant acenocumarol when
used in conjunction versus alone.
Patients were
divided into intermediate and high risk categories based on
history of prior embolism or mitral stenosis. Patients were
followed for a period of up to four years, with the primary
outcome being a composite of vascular death, transient ischemic
attack and non-fatal stroke or systemic embolism, whichever came
first.
The results
showed that the combined therapy group had a lower rate of
embolism-stroke-TIA than the antiplatelet only group, and a
lower rate of vascular death than the anticoagulant only group.
Furthermore, there was a 61% relative reduction in primary
outcome plus severe bleeding in the combination therapy group
compared to both other groups in the intermediate risk patient
category.
These results
indicate that combined antiplatelet plus moderate intensity
anticoagulation therapy is safe and effective in decreasing the
incidence of vascular events in patients with atrial
fibrillation, and does so without increasing bleeding risk.
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