Triple therapy in AF increases bleeding risk
By Lara Hutchins
Patients with atrial fibrillation who are taking the triple therapy combination of warfarin, clopidogrel and aspirin have a three-fold increased risk of bleeding complications compared to those just receiving warfarin.
Danish researchers followed up 82 854 patients discharged from hospital with a diagnosis of atrial fibrillation for an average 3.3 years.
They found the incidence of bleeding with the warfarin-aspirin-clopidogrel was 15.7% per patient-year, 13.9% per patient-year with warfarin and clopidogrel but just 3.9% per patient-year with warfarin alone.
Aspirin and clopidogrel monotherapy were associated with bleeding incidences of 3.7% and 5.6% per patient-year respectively.
The authors say their study confirms that - although triple therapy is highly effective and superior to dual platelet inhibitor therapy and oral anticoagulation therapy combined with aspirin – it has a poor safety profile.
Study leader Dr Morten Hansen, a cardiologist at the department of cardiology, Copenhagen University Hospital said: When indications exist for anticoagulant therapy and platelet inhibitor therapy, the [overall] benefit of combining treatments has not been demonstrated.
‘So combination therapy should be carefully considered and should be given only for a short time when treatments are mandatory.'
Arch Int Med. 2010;170(16):1433-1441Warfain increases bleeding risk