Journal article
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
The American heart journal, v 152(5), pp 967-973
01 Nov 2006
PMID: 17070169
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Aspirin is used in combination with anticoagulant therapy in patients with atrial fibrillation (AF), but evidence of additional efficacy is not available.
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.
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).
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.
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Details
- Title
- 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
- Creators
- Greg C. Flaker - University of MissouriMichael Gruber - University of Wisconsin–MadisonStuart J. Connolly - McMaster UniversitySteven Goldman - Tucson Veteran's Hospital, Tucson, AZSandra Chaparro - University of MissouriAlec Vahanian - Hôpital TenonMatti O. Halinen - Kuopio University HospitalJay Horrow - AstraZeneca (United States)Jonathan L. Halperin - Mount Sinai Hospitalthe SPORTIF Investigators
- Publication Details
- The American heart journal, v 152(5), pp 967-973
- Publisher
- Mosby, Inc
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Anesthesiology and Perioperative Medicine
- Web of Science ID
- WOS:000241745800034
- Scopus ID
- 2-s2.0-33750392481
- Other Identifier
- 991020785752004721
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- Collaboration types
- Industry collaboration
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems