Combination Treatment Entails Risks
Trappe mentions the ACTIVE-A study in his review article on atrial fibrillation (2). Even though he does not take any particular position, the description suggests that ASA plus clopidogrel is superior to monotherapy with ASA in patients with atrial fibrillation (with an indication for coumarin treatment in coexisting contraindications or refusal of treatment). When considering the risk-benefit ratio, this cannot be deduced from the data of the cited study. As explained in the Arzneimitteltelegramm newsletter (1), the risk of hemorrhage is notably higher in patients with dual platelet inhibition, so that altogether no advantage has been shown for combination treatment in the patient group under study. It is incomprehensible to me that the current article did not even mention the increased risk of combination therapy.
Dr. med. Bernhard Lache
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Arzneimitteltelegramm 2009; 40: 45–6.|
|2.||Trappe HJ: Atrial fibrillation: established and innovative methods of evaluation and treatment. Dtsch Artzebl Int 2012; 109(1–2): 1–7. VOLLTEXT|