Effectiveness and safety of combined antiplatelet and anticoagulant therapy: a critical review of the evidence from randomized controlled trials.

Abstract

Antiplatelet and anticoagulant drugs are effective for the prevention of arterial and venous thrombosis but patients continue to experience major cardiovascular events despite their use. Strategies to improve the effectiveness of antithrombotic therapies include selecting the optimal drug and dosing regimen, the use of combinations of antiplatelet and anticoagulant drugs and the development of new more effective drugs to replace existing therapies. Evidence from randomized controlled trials indicates that the combination of aspirin and an anticoagulant is more effective than aspirin alone for the prevention of recurrent cardiovascular events in patients with acute coronary syndrome and is more effective than anticoagulation alone for the prevention of thromboembolic events in patients with mechanical heart valves, but at a cost of increased bleeding. Randomized controlled trials provide no evidence for improved effectiveness of combination therapy compared with antiplatelet therapy alone for the prevention of recurrent cardiovascular events in patients with non-cardioembolic stroke or peripheral artery disease, or compared with anticoagulant therapy alone for the prevention of stroke in patients with atrial fibrillation. Despite lack of evaluation in randomized controlled trials, combination therapy is commonly used in patients with separate indications for antiplatelet therapy (e.g., acute coronary syndrome, recent coronary artery stent) and anticoagulant therapy (e.g., atrial fibrillation with at least one additional risk factor for stroke). Randomized trials are urgently required to evaluate the effectiveness and safety of combining antiplatelet and anticoagulant therapy in these settings.

• Authors: Jeremy S Paikin, Doug S Wright, John W Eikelboom
• Journal: Blood reviews (Blood Rev) Vol. 25 Issue 3 Pg. 123-9 (May 2011) ISSN: 1532-1681 [Electronic] England
• PMID: 21354678 (Publication Type: Journal Article, Meta-Analysis, Review)
• Copyright: Copyright © 2011 Elsevier Ltd. All rights reserved.

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors
• Aspirin

Topics

• Anticoagulants (adverse effects, therapeutic use)
• Aspirin (therapeutic use)
• Drug Therapy, Combination
• Humans
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Randomized Controlled Trials as Topic