Pharmacy Times, Volume 0, 0

Warfarin therapy is more effectivethan clopidogrel plus low-dose aspirinin preventing vascular events inpatients with atrial fibrillation (AF) and 1or more risk factors for stroke. TheAtrial fibrillation Clopidogrel Trial withIrbesartan for prevention of VascularEvents (ACTIVE-W) study enrolled morethan 6700 patients. The investigatorscompared warfarin (international normalizedratio target 2-3) versus clopidogrel75 mg daily combined with aspirin75 to 100 mg daily for the prevention offirst occurrence of stroke, non-centralnervous system systemic embolism,myocardial infarction, or vasculardeath.Warfarin therapy was associatedwith a 44% relative risk reduction inthese events.

Patients who were already receivingwarfarin treatment at study entry had atrend toward a greater reduction in vascularevents and a significantly lower riskof major bleeding events with oral anticoagulationthan patients who were noton this therapy at study entry. The studywas discontinued early because of theclear superiority of warfarin therapy.

Dr. Garrett is a clinical pharmacistpractitioner at Cornerstone Health Carein High Point, NC.