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Oral anticoagulation alone or in combination with aspirin: risks and benefits
J Hafner1, P de Moerloose, H Bounameaux
1Department of Internal Medicine, University Hospital of Geneva.
Insights
Combining oral anticoagulants with antiplatelet agents for arterial thromboembolism prophylaxis is common but risky. Current evidence is limited, suggesting this combination should be avoided until further trials confirm its benefit-risk ratio.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Research
Background:
- Combined oral anticoagulants and antiplatelet agents are frequently used for arterial thromboembolism prophylaxis.
- Indications include atrial fibrillation, heart valve prostheses, coronary artery disease, stents, and peripheral arterial occlusive disease.
- This combination may increase bleeding risk, with limited clinical trial data available.
Purpose of the Study:
- To review the literature on combined oral anticoagulants and aspirin for arterial thromboembolism prevention and treatment.
- To compare this combination with monotherapy (oral anticoagulation alone or aspirin alone).
Main Methods:
- Literature review of clinical trials and studies.
- Comparative analysis of combination therapy versus monotherapy.
Main Results:
- Evidence supporting the combination therapy is sparse and trials are often inhomogeneous.
- The benefit-to-risk ratio of combined therapy is not well-established for most indications.
Conclusions:
- The combination of oral anticoagulants with aspirin is potentially dangerous and not recommended for most indications.
- Further specifically designed trials are needed to evaluate the benefit-to-risk ratio before widespread recommendation.
Abstract:
The combination of oral anticoagulants with antiplatelet agents has been advocated as particularly efficient in prophylaxis of arterial thromboembolism. The indications at issue are nonrheumatic chronic atrial fibrillation, mechanical and biological heart valve prostheses, coronary artery disease, coronary stents and peripheral arterial occlusive disease. However, such a combined prophylaxis might also be associated with a higher bleeding risk. Clinical trials addressing administration of coumarines with antiaggregants are rare and inhomogeneous. The present article reviews the literature on oral anticoagulants combined with aspirin in the prevention and treatment of arterial thromboembolism and draws a comparison to oral anticoagulation alone and aspirin alone, respectively. It clearly shows that this potentially dangerous combination should not be recommended in most indications until specifically designed trials have addressed its benefit-to-risk ratio.