The DOI matches its Crossref record; 23 of the 24 references it cites were found in a registry or an index.
Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial
Abstract
Background Oral anticoagulation therapy reduces risk of vascular events in patients with atrial fibrillation. However, long-term monitoring is necessary and many patients cannot achieve optimum anticoagulation. We assessed whether clopidogrel plus aspirin was non-inferior to oral anticoagulation therapy for prevention of vascular events.Methods Patients were enrolled if they had atrial fibrillation plus one or more risk factor for stroke, and were randomly allocated to receive oral anticoagulation therapy (target international normalised ratio of 2.0-3.0; n=3371) or clopidogrel (75 mg per day) plus aspirin (75-100 mg per day recommended; n=3335). Outcome events were adjudicated by a blinded committee. Primary outcome was first occurrence of stroke, non-CNS systemic embolus, myocardial infarction, or vascular death. Analyses were by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00243178.Results The study was stopped early because of clear evidence of superiority of oral anticoagulation therapy. There were 165 primary events in patients on oral anticoagulation therapy (annual risk 3.93%) and 234 in those on clopidogrel plus aspirin (annual risk 5.60%; relative risk 1.44 (1.18-1.76; p=0.0003). Patients on oral anticoagulation therapy who were already receiving this treatment at study entry had a trend towards a greater reduction in vascular events (relative risk 1.50, 95% CI 1.19-1.89) and a significantly (p=0.03 for interaction) lower risk of major bleeding with oral anticoagulation therapy (1.30; 0.94-1.79) than patients not on this treatment at study entry (1.27, 0.85-1.89 and 0.59, 0.32-1.08, respectively).Conclusion Oral anticoagulation therapy is superior to clopidogrel plus aspirin for prevention of vascular events in patients with atrial fibrillation at high risk of stroke, especially in those already taking oral anticoagulation therapy.
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“VKA therapy prevents stroke, non-central nervous system embolus, myocardial infarction, and vascular death better than single or dual antiplatelet therapy with aspirin and clopidogrel (annual risk of 5.6% for aspirin and clopidogrel vs. 3.9% with VKA therapy).431”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [431]
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“For decades, anti-coagulation with vitamin K antagonists (VKAs) has been the standard care for the prevention of thromboembolic events in patients with AF, since warfarin is proven to be more effective than aspirin and dual antiplatelet therapy in reducing cerebral events [11–13].”
BackgroundΤζιόμαλος, Κ., Giampatzis, V., Bouziana, S. D., Spanou, M., Kostaki, S., Papadopoulou, M., Dourliou, V., Sofogianni, A., Savopoulos, C. G., & Hatzitolios, A. I. (2015) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-015-1262-y · Cited by 9
Impact of Atrial Fibrillation and Sinus Rhythm Restoration on Reticulated Platelets
Tafur, A. J., McBane, R. D., Ammash, N. M., Asirvatham, S. J., Miller, R. D., Janczak, D. T., Slusser, J. P., Grill, D. E., Whelan, S. L., & Wysokiński, W. E. (2015) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2015.09.013 · Cited by 9
Dabigatran in atrial fibrillation: pharmacology and clinical trials
Ezekowitz, M. D., & Nagarakanti, R. (2011) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-011-9593-x · Cited by 9
de Andrés-Nogales, F., Oyagüez, I., Nicolás, L. B., Fontcuberta, C. C., & Soto-Álvarez, J. (2014) · Revista Clínica Española (English Edition) · doi:10.1016/j.rceng.2014.08.003 · Cited by 9
Martín‐Yuste, V., Brugaletta, S., González, I. F., Cola, C., Alvarez-Contreras, L. R., de Antonio, M., Vicens Martí, C., García‐Picart, J., & Sabaté, M. (2011) · EuroIntervention · doi:10.4244/eijv6i7a143 · Cited by 9
Balucani, C., Barlinn, K., Živanović, Ž., Parnetti, L., Silvestrini, M., & Alexandrov, A. V. (2010) · Stroke Research and Treatment · doi:10.4061/2010/427418 · Cited by 9
Antithrombotic and Anticoagulant Therapy for Atrial Fibrillation
Dzeshka, M. S., & Lip, G. Y. H. (2014) · Cardiology Clinics · doi:10.1016/j.ccl.2014.07.009 · Cited by 10
Unanswered Questions in Patients With Concurrent Atrial Fibrillation and Acute Coronary Syndrome
Ice, D. S., Shapiro, T. A., Gnall, E., & Kowey, P. R. (2013) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2013.11.046 · Cited by 9
Pasceri, V., Patti, G., Pristipino, C., Pelliccia, F., Irini, D., Varveri, A., Roncella, A., Sciascio, G. D., & Speciale, G. (2009) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.22380 · Cited by 9
Gattellari, M., Leung, D. Y., Ukoumunne, O. C., Zwar, N. A., Grimshaw, J., & Worthington, J. M. (2011) · Implementation Science · doi:10.1186/1748-5908-6-48 · Cited by 9
Stroke Prevention in Atrial Fibrillation
Haft, J. I. (2012) · Clinical and Applied Thrombosis/Hemostasis · doi:10.1177/1076029612458148 · Cited by 10
“Antiplatelet agents, such as aspirin and clopidogrel, are not subject to many of the issues outlined above, but they are considerably less efficacious than warfarin.(6,16) Current ACCP guidelines recommend that patients with AF who are at intermediate or high risk of stroke receive oral anticoagulants rather than aspi…”
BackgroundCardioembolic stroke: a variety of causes and current approaches to its prevention
Гераскина, Л. А. (2013) · Neurology neuropsychiatry Psychosomatics · doi:10.14412/2074-2711-2013-2457 · Cited by 9
Hirai, T., Hamada, Y., Geka, Y., Kuwana, S., Hirai, K., Ishibashi, M., Fukaya, Y., & Kimura, T. (2017) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-017-2316-1 · Cited by 9
Clinical Profile of Atrial Fibrillation in Tertiary Hospital in Central Nepal
Dhungel, S., & Laudari, S. (2017) · Journal of Nepal Medical Association · doi:10.31729/jnma.3276 · Cited by 9
Optimal long-term antithrombotic management of atrial fibrillation: life cycle management
Pisters, R., Elvan, A., Crijns, H. J. G. M., & Hemels, M. E. W. (2018) · Netherlands Heart Journal · doi:10.1007/s12471-018-1118-0 · Cited by 9
Triple antithrombotic therapy for atrial fibrillation and coronary stents.
Shmyr, D., der Merwe, V. V., Yakiwchuk, E., Barry, A. R., & Kosar, L. (2017) · Europe PMC (PubMed Central) · Cited by 9
Acute coronary syndrome in elderly: aspects of patient management
Ryzhkova, Y. D., Kanareikina, E. V., Atabegashvili, M. R., Константинова, Е. В., & Gilyarov, M. Y. (2019) · The Clinician · doi:10.17650/1818-8338-2019-13-1-2-19-26 · Cited by 9
“В связи с тем, что ДАТ не продемонстрировала достаточную эффективность в отношении профилактики ишемических инсультов у пациентов с фибрилляцией [18], возникает необходимость назначения”
Kawakami, S., Yasuda, S., & Ogawa, H. (2020) · Journal of Cardiology · doi:10.1016/j.jjcc.2020.03.001 · Cited by 11
Metadata
- Authors
- ‡
- Corresponding author
- ‡
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2006-06
- Volume
- 367
- Issue
- 9526
- Pages
- 1903-1912
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2159193915
- Cited by
- 1,952
- References
- 24
- Citations by year
- 2026: 20 · 2025: 22 · 2024: 33 · 2023: 44 · 2022: 44 · 2021: 68 · 2020: 68 · 2019: 82 · 2018: 92 · 2017: 87 · 2016: 107 · 2015: 118 · 2014: 134 · 2013: 155 · 2012: 208
- FWCI
- 77.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Sanofi
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, clopidogrel, aspirin, oral anticoagulation, stroke prevention, vascular events, major bleeding, anticoagulation monitoring, clopidogrel resistance, irbesartan, antiplatelet therapy, vascular death, myocardial infarction
- MeSH terms
- Clopidogrel, Irbesartan, Aged, Anticoagulants, Aspirin, Atrial Fibrillation, Biphenyl Compounds, Drug Therapy, Combination, Humans, Platelet Aggregation Inhibitors, Risk Factors, Severity of Illness Index, Tetrazoles, Ticlopidine, International Normalized Ratio, Stroke
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