Do combinations of warfarin, aspirin, and clopidogrel increase the risk of bleeding compared to warfarin monotherapy in patients with atrial fibrillation?
In patients with atrial fibrillation, combining warfarin with antiplatelet agents significantly increases bleeding risk, with dual (warfarin + clopidogrel) and triple therapy carrying a >3-fold higher risk compared to warfarin alone.
In patients with AF, all combinations of warfarin, aspirin, and clopidogrel are associated with increased risk of nonfatal and fatal bleeding. Dual warfarin and clopidogrel therapy and triple therapy carried a more than 3-fold higher risk than did warfarin monotherapy.
Hansen et al. (Mon,) studied this question.