Should patients taking warfarin (Coumadin) for stroke prophylaxis also be on an antiplatelet agent, such as aspirin or clopidogrel (Plavix)?
—Nazem Abdelfattah, MD, Grand Blanc, Mich.

Warfarin alone is sufficient to prevent stroke from possible cardiovascular embolic sources, such as mitral stenosis, aortic atheroma, atrial fibrillation, etc. For CAD, you need an antiplatelet agent (either aspirin or clopidogrel). This is also true for preventing recurrent noncardiac embolic ischemic strokes in general. Warfarin is of no advantage over aspirin in preventing these recurrent ischemic strokes (N Engl J Med. 2001;345:1444-1451).
—Peter F. Cohn, MD (114-1)

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