Tuesday, April 14, 2009


This ACC presentation was also published in NEJM:

Conclusions In patients with atrial fibrillation for whom vitamin K–antagonist therapy was unsuitable, the addition of clopidogrel to aspirin reduced the risk of major vascular events, especially stroke, and increased the risk of major hemorrhage.

The major event reduction was for stroke. The benefit over and above the bleeding risk was fairly slim.

Given that anti-platelet therapy does not address the mechanism of stroke induced by atrial fibrillation, how does this strategy work? Probably by reducing platelet mediated events at the surface of atherosclerotic plaques, which has nothing to do with atrial fibrillation.

In patients with atrial fibrillation warfarin remains the drug of choice absent contraindications.

Medscape-Heartwire’s report is here.

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