Does the Combination of Warfarin and Aspirin Have a Place in Secondary Stroke Prevention?

The combined use of warfarin plus aspirin for secondary stroke prevention occurs primarily in patients with atrial fibrillation (AF) who have concomitant coronary artery disease (CAD). This drug combination is also used in patients with mechanical heart valves or occasionally in stroke/TIA patients who are deemed to be at high-risk for recurrent events. It is estimated that approximately 20% of patients on warfarin also receive aspirin and aside from patients with mechanical heart valves the use of this combination is tenuous.1,2The most common clinical scenario for using warfarin plus aspirin is for primary or secondary stroke prevention in AF patients who also have CAD. The rationale for using this combination typically is the widespread belief that the use of warfarin, although clearly of benefit for stroke risk reduction, should be supplemented with aspirin for reducing the risk of coronary ischemic events. The basis for this assumption is unclear, and the combined use of warfarin plus aspirin substantially increases the risk of major bleeding side effects, including intracerebral hemorrhage (ICH).2 The efficacy of aspirin for reducing ischemic …