A Cochrane systematic review of four randomized and clopidogrel rather than aspirin (75 mg to 325 mg once daily) alone (Grade 1B). 3.0 Antithrombotic Therapy for Patients With AF in Special Situations 3.1 Patients With AF and Stable Coronary Artery Disease Approximately one-third of patients with AF also have coronary artery disease.51 A recurring question is whether patients with AF for whom oral antico- agulation is indicated because of a high risk of stroke (eg, CHADS2 score of 2) and who have concom- itant stable coronary artery disease should also use aspirin to prevent coronary heart disease events. In this article, we de ne stable coronary artery disease as the presence (or absence) of angina but no revas- cularization procedure (percutaneous coronary inter- vention or coronary artery bypass graft surgery) or hospitalization for ACS (ie, unstable angina, non-ST- segment elevation MI, or ST-segment elevation MI) in the past year. The studies discussed next provide low-quality evidence that combination therapy with adjusted-dose VKA therapy plus aspirin is not associ- ated with reductions in stroke or MI but that it does increase by 1.5 to 2 times the risk of major bleeding compared with adjusted-dose VKA therapy alone. The FFAACS (Fluindione, Fibrillation Auriculaire, Aspirin et Contraste Spontane) trial is the only RCT that directly compared adjusted-dose VKA therapy and aspirin to adjusted-dose VKA therapy alone. In this study, patients in both arms received uindi- one (INR 2.0-2.6), and patients in the combination therapy arm also received aspirin 100 mg/d. The trial was stopped early after enrollment of only 157 patients because of excessive hemorrhage in the group receiving uindione plus aspirin.103 No con- clusion can be drawn regarding ef cacy for preven- tion of stroke or MI because there were so few events during a short duration of follow-up. 