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Aspirin plus warfarin is a combination therapy involving two oral anticoagulant and antiplatelet agents. Warfarin is a vitamin K antagonist that inhibits the synthesis of vitamin K–dependent clotting factors II, VII, IX, and X by blocking the enzyme vitamin K epoxide reductase, thereby reducing blood coagulation[6]. Aspirin (acetylsalicylic acid) irreversibly inhibits cyclooxygenase enzymes (COX-1 and COX-2), leading to decreased thromboxane A2 production and inhibition of platelet aggregation. The combination is sometimes used in patients with atrial fibrillation who have had an acute ischemic event or undergone coronary revascularization within the past year, or in those with mechanical heart valves[3][4][8]. However, this combination significantly increases the risk of major bleeding without clear additional benefit for most indications compared to monotherapy[1][2][3][4][5].
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