Antiplatelets Need Not Be Added to Anticoagulants in Atrial Fibrillation

Background: Non-valvular atrial fibrillation (NVAF) and ischemic cardiovascular disease are both associated with the development of ischemic stroke. The use of anticoagulant drugs (particularly direct oral anticoagulants [DOACs]) is recommended for strokes related to NVAF, whereas strokes related to atherosclerosis are usually managed with antiplatelet therapy. Objective: To determine whether it is beneficial to add an antiplatelet drug to anticoagulation among patients with known atherosclerotic disease and stroke complicating NVAF. Design: Multicenter, open-label, randomized controlled trial (RCT). Participants/Methods: 316 patients from 41 sites in Japan were recruited; mean age was 77.2 years, and 71.5% were male. All had suffered a transient ischemic attack or stroke in association with NVAF between 2016 and 2023. The antiplatelets involved were aspirin in 52%, clopidogrel in 31%, and cilostazol in 17%. Warfarin accounted for only 6% of each group, and the remainer were DOACs. R more...