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BMJ. 2007 July 28; 335(7612): 178.
PMCID: PMC1934460
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Combining aspirin and oral anticoagulants is unsafe in peripheral arterial disease

People with atherosclerotic peripheral arteries have a high risk of cardiovascular complications such as stroke and heart attack. Antiplatelet agents help lower the risk, and researchers reasoned that adding an oral anticoagulant might lower it further. But the results of a recent randomised trial were clear. Patients given both treatments were no less likely to have a stroke or a heart attack or to die from cardiovascular disease than controls given just an antiplatelet agent, such as aspirin or clopidogrel (relative risk 0.92, 95% CI 0.73 to 1.16). But they were significantly more likely to bleed. Life threatening, moderate, and minor bleeds were all more common in patients given anticoagulants during a mean follow-up of three years. Overall, they had a risk of haemorrhagic stroke more than 15 times higher than controls (15.2, 2.0 to 115.6, P=0.001). The authors looked for but failed to find any subgroup of patients who might benefit. They estimate that for every 1000 patients given anticoagulants for three years, there would be 24 fewer cardiovascular events but 28 more life threatening bleeds. The message is clear—patients with peripheral artery disease do not benefit from adding an oral anticoagulant to their existing treatment with an antiplatelet drug. The combination is unsafe.


  • N Engl J Med 2007;357:217-27 [PubMed]

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