Combining Aspirin With Oral Anticoagulant Therapy Is This a Safe and Effective Practice in Patients With Atrial Fibrillation?

In persons with cerebral ischemia caused by atrial fibrilla-tion (AF) and high risk of stroke based on an overall score of a validated risk stratification scheme such as CHADS2*, adjusted-dose warfarin is recommended for those who have no clinically significant contraindication.1,2 When there is AF, adjusted-dose warfarin is estimated to reduce the risk of stroke by about 60 % or more and by about 45 % more than aspirin.1 The combination of adjusted-dose warfarin plus aspirin administered to AF patients may offer theoretical advantages such as enhanced stroke prevention efficacy in high-risk persons or improved protection against myocardial ischemic events in those who have coronary artery disease or diabetes.3 The recently published American Heart Associa-tion/American Stroke Association recurrent stroke prevention guideline suggests, however, no data indicate that either increasing the intensity of oral anticoagulation or add-o