Clinical InvestigationElectrophysiologyRisks and benefits of combining aspirin with anticoagulant therapy in patients with atrial fibrillation: An exploratory analysis of stroke prevention using an oral thrombin inhibitor in atrial fibrillation (SPORTIF) trials
Section snippets
Methods
The rationale, design, and main results of the SPORTIF III and V studies have been published elsewhere.9, 10, 11 In brief, these randomized multicenter trials were designed to demonstrate the noninferiority of the oral direct thrombin inhibitor ximelagatran (36 mg twice daily), compared with vitamin K antagonist therapy with adjusted-dose warfarin (international normalized ratio [INR] 2-3) for prevention of all stroke and systemic embolism in high-risk patients with nonvalvular AF enrolled in
Results
Of the 7329 enrolled patients (3407 patients in SPORTIF III and 3922 patients in SPORTIF V), concurrent medication logs were unavailable for 25 patients, leaving data from 7304 patients available for secondary analysis. Of these, aspirin was prescribed to 531 patients in the ximelagatran group and 481 patients in the warfarin group. Thus, the current study compared the following groups at baseline: ximelagatran (n = 3120), ximelagatran plus aspirin (n = 531), warfarin (n = 3172), and warfarin
Discussion
This post hoc analysis involves patients given aspirin in addition to randomized anticoagulant therapy (either warfarin or ximelagatran) under a protocol that prohibited aspirin, except in limited dosage for patients considered at high risk, usually because of a clinical history of CAD. Patients taking aspirin on the advice of their physicians were therefore generally at higher risk for developing the cardiovascular events that served as end points in these studies. The combination of aspirin
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Fatal retroperitoneal hematoma associated with Covid-19 prophylactic anticoagulation protocol
2021, Radiology Case ReportsCitation Excerpt :The patient in our case had a creatinine clearance of only 29 mL/min; in patients with impaired renal function dose adjustment for Lovenox should be considered and Anti-Xa monitoring should be performed [18]. Aspirin use should also be taken into account as combined use of antiplatelet and anticoagulants can increase bleeding risk.[19] Initially part of the rationale for empiric high-dose anticoagulation therapy in Covid-19 patients was to avoid CT imaging entirely due to patient instability and concern regarding maintaining isolation precautions.
Optimal long-term antithrombotic treatment of patients with stable coronary artery disease and atrial fibrillation: “OLTAT registry”
2018, International Journal of CardiologyRisk of Myocardial Infarction in Anticoagulated Patients With Atrial Fibrillation
2018, Journal of the American College of CardiologyImpact of polyvascular disease on patients with atrial fibrillation: Insights from ROCKET AF
2018, American Heart JournalPreventing Myocardial Infarction in Patients With Atrial Fibrillation: Another Piece of the Puzzle
2017, Journal of the American College of CardiologyComparison of Anticoagulant Therapy for Atrial Fibrillation - Novel Oral Anticoagulants Versus Vitamin K Antagonists
2018, Progress in Cardiovascular Diseases
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Drs Flaker, Connolly, Goldman, and Halinen have received research grants from AstraZeneca.
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Drs Flaker, Connolly, and Halinen are on the AstraZeneca speaker's bureau.
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Dr Vahanian and Dr Halperin are consultants to AstraZeneca.
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Dr Horrow is an employee of AstraZeneca.