ACTIVE W Trial Summary: Clopidogrel + ASA vs. OAC for Atrial Fibrillation
2006 ACTIVE W TRIAL Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation Randomized, open treatment, controlled trial M Objective: Among patients with nonvalvular AF, how does combination aspirin/clopidogrel compare to warfarin in reducing the incidence of stroke, systemic embolism, MI, or CV death? Inclusion criteria: patients with AF and ≥1 additional 6,706 stroke risk factors (age≥75 y, age 55-74 years with patients either T2DM or prior CAD, HTN, prior stroke, TIA, HFrEF with LVEF <45%, PAD) A Aspirin + clopidogrel (n=3,371) VS Warfarin (n=3,335) 5.6 PRIMARY OUTCOME Stroke, non-CNS systemic embolus, MI, or CV death % RR 1.44; 95% CI 1.18-1.76; P=0.0003 SECONDARY OUTCOME H 3.9 8.32 Primary outcome event + major hemorrhage and death % 6.45 RR 1.31; 95% CI 1.12-1.54; P=0.0008 2.42 Major hemorrhage % 2.21 RR 1.10; 95% CI 0.83-1.45; P=0.53 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. Connolly SJ, et al. The Lancet. 2006. 367(9526):1903-12.