Combination of clopidogrel and aspirin for reduction of vascular events in patients with atrial fibrillation

Atrial fibrillation (AF) is the most common heart rhythm disorder and increases the risk for stroke by fivefold. Therefore, antithrombotic pharmacological agents are recommended and commonly used to prevent stroke and thromboembolic vascular events in patients with AF. Although, aspirin is an effective and acceptable agent for low-risk patients, oral vitamin K antagonists anticoagulants have superiority over aspirin in patients with AF who are at high risk for complications. However, given several practical impediments, vitamin K antagonists may not be suitable for certain high-risk patients with AF. It is not unusual for clinicians to encounter situations where selection of appropriate pharmacotherapy options for stroke prevention may be quite challenging in high-risk patients with AF who are deemed to be unsuitable candidates for oral anticoagulants. It may be hypothesized that, in such a situation, a combination of clopidogrel with aspirin, possibly by their additive effect in the prevention of platelet-mediated thrombosis may be used effectively instead of oral anticoagulants. In this article, we have discussed this issue and review one of the recently published Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE) studies, the ACTIVE-A trial, in which the treatment strategies utilizing 'clopidogrel plus aspirin' and 'aspirin alone' in patients with AF who were at increased risk for stroke and for whom therapy with a vitamin K antagonist was considered unsuitable were compared.