Aspirin--anticoagulant combination in patients with non valvular atrial fibrillation commentary on the FFAACS study results.

The prevention of the thromboembolic complications of chronic atrial fibrillation remains a therapeutic challenge because they cannot be completely suppressed by vitamin K antagonists with a target international normalized ratio between 2 and 3. Evaluation of the combination at that international normalized ratio level with antiplatelet therapy was the aim of the placebo-controlled double-blind Fluindione Fibrillation Auriculaire, Aspirine et Contraste Spontané (FFAACS) study with fluindione (as anticoagulant) and aspirin (100 mg) in patients with chronic atrial fibrillation at high risk of thromboembolic complications. The study was prematurely stopped because of insufficient recruitment rate resulting in very low power. An increase of minor bleeding complications was observed in the combination arm. Given these preliminary results, this combination cannot be recommended in such patients. The question remains with respect to antithrombotic therapy in patients with atrial fibrillation if the risk of severe bleeding complications outweighs the benefit of avoiding ischemic stroke.