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).
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