In this randomized trials of 7554 patients with atrial fibrillation, who were not candidates for warfarin, and had at least 1 risk factor for stroke, were randomized to ASA or ASA + plavix. After 3.6 years follow, those in the combined group had lower risk of stroke (2.4% versus 3.3% per year) and lower risk of vascular events (stroke, MI, non-CNS emboli, or death) (6.8% versus 7.6% per year). Major bleeding (primarily GI bleeding) was more common in the combination group (2% versus 1.3% per year). In patients at low risk for GI bleeding, high risk for stroke, and no candidacy for warfarin, ASA + plavix is a reasonable alternative (abstract).
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.