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CONCOMITANT USE OF ANTIPLATELET AND ORAL ANTICOAGULATION AMONG PATIENTS WITH ATRIAL FIBRILLATION: INSIGHTS FROM THE PROSPECTIVE SPRINT-AF REGISTRY
452 JACC March 21, 2017 Volume 69, Issue 11
Arrhythmias and Clinical EP CONCOMITANT USE OF ANTIPLATELET AND ORAL ANTICOAGULATION AMONG PATIENTS WITH ATRIAL FIBRILLATION: INSIGHTS FROM THE PROSPECTIVE SPRINT-AF REGISTRY Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Atrial Fibrillation and VT: Specific Situations and Newer Outcome Measures Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias Presentation Number: 1190-100 Authors: Milan Gupta, Yan Yan Wu, Mahesh Kajil, Michelle Tsigoulis, Jafna Cox, Paul Dorian, Carl Fournier, David Gladstone, Evan Lockwood, G. B. John Mancini, Ashfaq Shuaib, Narendra Singh, Andrew Ha, CCRN, Brampton, Canada
Background: For patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC) for stroke prevention, concomitant use of antiplatelet (AP) agents increases bleeding risk without necessarily reducing ischemic vascular events. From a contemporary prospective registry, we sought to identify factors associated with OAC+AP vs. OAC use in a cohort of Canadian AF patients.
Methods: We enrolled 2,499 AF patients from 133 sites in Canada (Nov 2013 to March 2016) in a prospective observational registry. Here, we report on data from the first 2,215 patients enrolled. Demographics of patients treated with OAC+AP (primarily aspirin) vs. OAC alone were identified. Multivariable logistic regression with a backward selection algorithm was performed to identify factors associated with OAC+AP vs. OAC use. Results: There were 1,795 (81%) OAC-treated patients and 288 (16%) of them were treated with concomitant AP. With bivariate logistic regression, patients treated with OAC+AP vs. OAC alone were similar in age (75.0±10.0 vs. 74.6±9.5 years, p=0.5) while those in the OAC+AP group were more likely to: be male, diabetic, have heart failure, stroke/TIA, or vascular disease (stable CAD, acute coronary syndrome, percutaneous coronary intervention, coronary artery bypass surgery, or peripheral vascular disease). On multivariable analysis, male sex (OR 1.4, 95% CI 1.1-1.9, P=0.02) and vascular disease (OR 3.8, 95% CI 2.9-4.9, P<0.01) were associated with higher odds of OAC+AP use. In the OAC+AP subgroup, 126 (44%) patients did not have a history of vascular disease. Conclusions: In this contemporary AF registry, AP was co-prescribed in one sixth of OAC-treated patients. Vascular disease was strongly associated with higher odds of OAC+AP use. This suggests that the perceived incremental gain in vascular protection from AP use may outweigh the reality of bleeding when treatment decisions are made by physicians. In addition, there was a substantial proportion of patients without known vascular disease who were treated with OAC+AP, despite absence of a clear indication for AP use. These findings highlight the need to avoid AP over-prescription amongst OAC-treated patients in order to minimize bleeding.
Arrhythmias and Clinical EP CONCOMITANT USE OF ANTIPLATELET AND ORAL ANTICOAGULATION AMONG PATIENTS WITH ATRIAL FIBRILLATION: INSIGHTS FROM THE PROSPECTIVE SPRINT-AF REGISTRY Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Atrial Fibrillation and VT: Specific Situations and Newer Outcome Measures Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias Presentation Number: 1190-100 Authors: Milan Gupta, Yan Yan Wu, Mahesh Kajil, Michelle Tsigoulis, Jafna Cox, Paul Dorian, Carl Fournier, David Gladstone, Evan Lockwood, G. B. John Mancini, Ashfaq Shuaib, Narendra Singh, Andrew Ha, CCRN, Brampton, Canada
Background: For patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC) for stroke prevention, concomitant use of antiplatelet (AP) agents increases bleeding risk without necessarily reducing ischemic vascular events. From a contemporary prospective registry, we sought to identify factors associated with OAC+AP vs. OAC use in a cohort of Canadian AF patients.
Methods: We enrolled 2,499 AF patients from 133 sites in Canada (Nov 2013 to March 2016) in a prospective observational registry. Here, we report on data from the first 2,215 patients enrolled. Demographics of patients treated with OAC+AP (primarily aspirin) vs. OAC alone were identified. Multivariable logistic regression with a backward selection algorithm was performed to identify factors associated with OAC+AP vs. OAC use. Results: There were 1,795 (81%) OAC-treated patients and 288 (16%) of them were treated with concomitant AP. With bivariate logistic regression, patients treated with OAC+AP vs. OAC alone were similar in age (75.0±10.0 vs. 74.6±9.5 years, p=0.5) while those in the OAC+AP group were more likely to: be male, diabetic, have heart failure, stroke/TIA, or vascular disease (stable CAD, acute coronary syndrome, percutaneous coronary intervention, coronary artery bypass surgery, or peripheral vascular disease). On multivariable analysis, male sex (OR 1.4, 95% CI 1.1-1.9, P=0.02) and vascular disease (OR 3.8, 95% CI 2.9-4.9, P<0.01) were associated with higher odds of OAC+AP use. In the OAC+AP subgroup, 126 (44%) patients did not have a history of vascular disease. Conclusions: In this contemporary AF registry, AP was co-prescribed in one sixth of OAC-treated patients. Vascular disease was strongly associated with higher odds of OAC+AP use. This suggests that the perceived incremental gain in vascular protection from AP use may outweigh the reality of bleeding when treatment decisions are made by physicians. In addition, there was a substantial proportion of patients without known vascular disease who were treated with OAC+AP, despite absence of a clear indication for AP use. These findings highlight the need to avoid AP over-prescription amongst OAC-treated patients in order to minimize bleeding.