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This Figure shows TTR data from the ACTIVE (Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events) W trial,[87] assessing antiplatelet therapy with aspirin plus clopidogrel (Plavix; Bristol-Myers Squibb/Sanofi) versus warfarin in 7554 patients with AFib and at least one risk factor for stroke. The Figure shows that if the time in therapeutic range (TTR) is <65%, there was no difference in event rates between antiplatelet and anticoagulant therapy. For patients with TTR ≥65%, however, the relative risk of events was more than double (RR=2.14, p=0.0001) for patients on aspirin plus clopidogrel instead of warfarin. In other words, there is a dramatic benefit in favor of the oral anticoagulant agent, but only when warfarin is administered correctly; being on warfarin, but not in the therapeutic range consistently, is not effective therapy.
Reiffel JA. Am J Med 2013; 126: 00-00.
[87] Connolly SJ, Pogue J, Eikelboom J, et al; ACTIVE W Investigators. Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation. 2008;118:2029-2037.