Key result
Antiplatelets alone or with OAC are linked to higher mortality versus OAC alone in AF.
Why the study?
Because ischemic stroke/TIA, major bleeding, and death are common outcomes in AF, the study sought to investigate clinical event rates across different antithrombotic strategies.
Does antiplatelet therapy alone or in combination with OAC alter the risk of ischemic stroke/TIA, major bleeding, and death compared to OAC alone in patients with atrial fibrillation?
Cohort (n=3,148)
Yes
Does antiplatelet therapy alone or in combination with OAC alter the risk of ischemic stroke/TIA, major bleeding, and death compared to OAC alone in patients with atrial fibrillation?
In patients with atrial fibrillation, using antiplatelet therapy alone or adding it to an oral anticoagulant increases the risk of adverse outcomes, including death, compared to oral anticoagulation alone.
May increase mortality risk in AF; leaves open confirmation by randomized trials before changing practice.
Background: Ischemic stroke/transient ischemic attack (TIA), major bleeding, and death are common outcomes in atrial fibrillation (AF) patients, so appropriate antithrombotic therapy is crucial. The objective of this study was to investigate the rate of ischemic stroke/TIA, major bleeding, and death compared among AF patients who received oral anticoagulant (OAC) alone, antiplatelet alone, or OAC plus antiplatelet. Methods: Prospective data from the COOL-AF Registry (Thailand's largest multicenter nationwide AF registry) were analyzed. Clinical, laboratory, and medication data were collected at baseline and during follow-up. Clinical outcomes, including ischemic stroke/TIA, major bleeding, and death, were collected. Results: There were 3,148 patients included. Mean age was 68.1 ± 10.8 years and 1,826 (57.7%) were male. AF was paroxysmal in 998 (31.7%), persistent in 603 (19.2%), and permanent in 1,547 (49.1%). The mean follow-up duration was 25.7 ± 10.6 months. The median rates of ischemic stroke/TIA, major bleeding, and death were 1.49 (1.21-1.81), 2.29 (1.94-2.68), and 3.89 (3.43-4.40) per 100 person-years. Antiplatelet alone, OAC plus antiplatelet, and OAC alone were used in 582 (18.5%), 308 (9.8%), and 2,258 (71.7%) patients, respectively. Antiplatelet alone significantly increased the risk of ischemic stroke/TIA and death compared to OAC alone. OAC plus antiplatelet significantly increased the risk of death compared to OAC alone. Conclusions: Antiplatelet was used in 890 (28.3%) AF, of whom 582 (18.5%) received antiplatelet alone, and 308 (9.8%) received antiplatelet and OAC. OAC plus antiplatelet significantly increased the risk of death without additional stroke prevention benefit. Antiplatelet alone should not be used in patients with AF.
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Krittayaphong et al. (2022) conducted a cohort in Atrial fibrillation (n=3,148). Antiplatelet alone or OAC plus antiplatelet vs. OAC alone was evaluated on Ischemic stroke/TIA, major bleeding, and death. Antiplatelet therapy alone or combined with OAC significantly increased the risk of death compared to OAC alone in AF patients (overall death rate 3.89 per 100 person-years).
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