ORAL ANTICOAGULATION ALONE OR IN COMBINATION WITH ASPIRIN - RISKS ANDBENEFITS

The combination of oral anticoagulants with antiplatelet has been advo cated as particularly efficient in pro phylaxis of arterial thromboemb olism. The indications at issue are nonrheumatic chronic atrial fibril lation, mechanical and biological heart valve prostheses, coronary art ery disease, coronary stents and peripheral arterial occlusive disease . However, such a combined prophylaxis might also be associated with a higher bleeding risk. Clinical trials addressing administration of co umarines with antiaggregants are rare and inhomogeneous. The present a rticle reviews the literature on oral anticoagulants combined with asp irin in the prevention and treatment of arterial thromboembolism and d raws a comparison to oral anticoagulation alone and aspirin alone, res pectively. It clearly shows that this potentially dangerous combinatio n should nor be recommended in most indications until specifically des igned trials have addressed its benefit-to-risk ratio.