Key result
Adding aspirin to DOACs in AF linked to ~319% higher major bleeding risk without ischemic benefit.
Why the study?
Limited data exist regarding the safety and efficacy of low-dose aspirin for primary prevention of ASCVD in patients with AF receiving a DOAC for thromboembolism prevention.
Does the addition of low-dose aspirin to DOAC therapy improve ischemic outcomes or increase bleeding in patients with atrial fibrillation and no history of ASCVD?
Population
611 patients 18 to 79 years of age with AF and no history of ASCVD
Comparison
Apixaban or rivaroxaban plus low-dose aspirin vs DOAC monotherapy
Design
Multicenter retrospective cohort study
Authors
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May support deprescribing aspirin in AF on DOACs without ASCVD; leaves open confirmation of ischemic neutrality in randomized trials.
Does the addition of low-dose aspirin to DOAC therapy improve ischemic outcomes or increase bleeding in patients with atrial fibrillation and no history of ASCVD?
Adding low-dose aspirin to DOAC therapy in AF patients without prior ASCVD significantly increases major bleeding risk without reducing ischemic events, supporting the deprescribing of aspirin in this population.
Yzaguirre et al. (2025) studied this question. Adding low-dose aspirin to DOAC therapy in patients with AF significantly increased major bleeding risk (5.74 vs 1.37 per 100 patient-years) without reducing ischemic events.
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