Oral Anticoagulants vs. Antiplatelet Therapy

摘要

Intracranial or extracranial hemorrhage is more common with anticoagulation and must be weighed against its therapeutic benefit.1 Practice Pointers Cardioembolic stroke afflicts 60,000 Americans annually and is most often caused by atrial fibrillation,2 which affects 5 percent of adults older than 65 years and 10 percent older than 80 years.1 Patients with atrial fibrillation who receive antiplatelet therapy alone have a 4 percent annual risk of stroke, although the more recent AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) study puts the estimate closer to 2.5 percent.1,3 Since the Stroke Prevention in Atrial Fibrillation (SPAF) trials were launched in 1987, more than a dozen studies have looked at anticoagulation in atrial fibrillation. The size of the studies varied greatly and ranged from a small cohort of 31 participants with poorly matched treatment groups to the more robust ACTIVE trial, where 6,706 patients (70 percent of the total meta-analysis population) were randomized to aspirin plus clopidogrel (Plavix; a treatment strategy that is no longer the standard of care) versus warfarin alone.