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Addition of Antiplatelet to Anticoagulant Therapy Increases Effectiveness in Patients with Valvular and Non-valvular Atrial Fibrillation 

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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