Should aspirin be added to anticoagulation?
In patients requiring anticoagulation, bleeding risk increases with the addition of antiplatelet agents.
Except in cases of unstable coronary disease or mechanical valves, this increased bleeding risk is not offset by a decrease in thrombotic events. Because ischemic stroke and intracerebral hemorrhage increase dramatically with age, patients presenting with stroke are quite different from those presenting with acute coronary syndromes.
As such, it is not valid to extrapolate stroke secondary prevention from cardiac studies, as the MATCH trial exemplified.
The decision to add aspirin to anticoagulation is a difficult one, best made collaboratively among patient, neurologist, and cardiologist.
