Abstract 15439: High Rates of antiplatelet Use in Atrial Fibrillation Patients Treated With Oral Anticoagulation: Insights from the Stroke Prevention and Rhythm Interventions in Atrial Fibrillation (SPRINT-AF) Registry
Introduction: Among patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC) for stroke prevention, concomitant use of antiplatelet (AP) agents increases bleeding risk and may not be associated with a significant reduction in the rates of vascular events. We sought to identify factors associated with OAC+AP vs. OAC use in a contemporary AF registry.
Methods: From December 2012 to July 2013, a cross-sectional analysis of 936 consecutive AF patients was performed. They were enrolled from 109 community practices (84 [77%] Primary Care practices) in 10 Canadian provinces. Demographics of patients treated with OAC+AP (primarily aspirin) vs. OAC alone were identified. Multivariable logistic regression was performed to identify factors associated with OAC+AP vs. OAC use.
Results: Seven hundred and eighty-two (83.1%) patients were treated with OAC, amongst whom 143 (18.3%) were treated with OAC+AP and 639 (81.7%) were treated with OAC alone. Amongst patients treated with OAC+AP, 59 (41.3%) did not have a history of coronary artery disease (CAD) (defined as history of stable CAD, acute coronary syndrome, percutaneous coronary intervention (PCI), or coronary artery bypass surgery) or peripheral arterial disease (PAD). In the OAC+AP group, 41 (28.7%) patients had PCI, 55 (38.5%) patients had diabetes, and 24 (16.8%) patients had a previous stroke or transient ischemic attack. Patient treated with OAC+AP vs. OAC alone did not significantly differ in age: 76.7 (71.2, 82.9) vs. 76.8 (69.5, 83.1) years (median, IQR). On multivariable analysis, CAD (OR 3.60, 95% CI 2.24 to 5.55, p<0.01) and male sex (OR 1.93, 95% CI 1.20 to 3.09, p=0.01) were associated with OAC+AP use.
Conclusions: In this contemporary AF registry, about 1 in 5 OAC-treated patients was also treated with AP. Although a history of CAD was associated with OAC+AP use, about 40% of patients did not have compelling indications for being treated with AP agents. The relatively high rate of concomitant AP use in OAC-treated AF patients presents a potential opportunity to reduce major bleeding. Efforts are needed to address this practice pattern to minimize over-prescription of AP in this population.
Author Disclosures: M.K. Gupta: Research Grant; Significant; Bayer. Honoraria; Modest; Bayer, Bristol-Meyer-Squibb, Pfizer. N. Singh: Research Grant; Modest; Bristol-Myers-Squibb, Boehringer-Ingleheim, Jaansen Pharma. Honoraria; Modest; Bayer, Boehringer-Ingleheim, Bristol-Myers-Squibb, Jaansen Pharma. J.L. Cox: Honoraria; Modest; Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, Pfizer. P. Dorian: Research Grant; Significant; Boehringer-Ingleheim. Honoraria; Modest; Boehringer-Ingleheim, Bristol-Meyer-Squibb, Pfizer, Sanofi. C. Fournier: Honoraria; Modest; Amgen, Astrazeneca, Boeringher Ingelheim, Bristol-Myers-Squibb, Forest Laboratories, Janssen, Merck, Eli-Lilly, Sanofi, GlaxoKlineSmith, Valeant Canada. Consultant/Advisory Board; Modest; Amgen, Astrazeneca, Boeringher Ingelheim, Bristol-Myers-Squibb, Forest Laboratories, Janssen, Merck, Novo Nordisk Canada, Sanofi, Takeda, Valeant Canada. G.J. Mancini: None. A. Shuaib: None. M. Kajil: None. M. Tsigoulis: None. A.C. Ha: Speakers Bureau; Modest; Bayer Inc.. Consultant/Advisory Board; Modest; Bayer Inc..
- © 2014 by American Heart Association, Inc.