Key result
Polypharmacy in atrial fibrillation patients starting vitamin K antagonists was an independent risk factor for major bleeding (HR 1.77; 95% CI 1.07-2.92) and thromboembolic events.
Why the study?
Previous evidence showed that AF patients with polypharmacy had increased probability of adverse events, prompting investigation into its prevalence, risk factors, and clinical impact in patients starting VKAs.
Does polypharmacy increase the risk of adverse clinical outcomes in atrial fibrillation patients starting vitamin K antagonists?
Cohort (n=1,050)
Does polypharmacy increase the risk of adverse clinical outcomes in atrial fibrillation patients starting vitamin K antagonists?
In a real-world cohort of atrial fibrillation patients starting vitamin K antagonists, polypharmacy is highly prevalent and independently associated with increased risks of major bleeding and thromboembolic events.
Polypharmacy was associated with higher major bleeding rates in AF patients on VKAs; leaves open whether targeted deprescribing improves net outcomes.
BACKGROUND: Previous evidence indicated that atrial fibrillation (AF) patients with polypharmacy presented increased probability of adverse events. We investigated the prevalence of polypharmacy, risk factors for polypharmacy, and the impact of polypharmacy in clinical outcomes in a 'real-world' cohort of AF patients starting vitamin K antagonists (VKAs). METHODS: Prospective study including AF outpatients starting VKA therapy from July, 2016 to June, 2018. At inclusion, all concomitant drugs were carefully collected and recorded. Polypharmacy was defined as the intake of ≥ 5 concomitant drugs. During 2-years of follow-up, ischemic strokes/transient ischemic attacks (TIAs), fatal/nonfatal myocardial infarctions (MIs), bleeding events, venous thromboembolisms, and all-cause deaths were recorded. RESULTS: 1050 patients (51.5 % females, median age 77 [69-83] years) were included, and the prevalence of polypharmacy was 32.9 % (345). Female sex (OR 1.5; 95 % CI 1.11-2.03), hypertension (OR 2.53; 95 % CI 1.51-4.22), diabetes (OR 3.11; 95 % CI 2.31-4.17), vascular disease (OR 3.08; 95 % CI 2.19-4.33), heart failure (OR 1.86; 95 % CI 1.35-2.58) and dyslipidemia (OR 2.61; 95 % CI 1.9-3.58) were independently associated to the polypharmacy. Patients with polypharmacy showed significantly higher incidence of major bleeding, net clinical outcomes (composite of major bleeding, ischemic stroke/TIA, and mortality), MACE (composite of ischemic stroke/TIA, MI, and cardiovascular death), and composite thrombotic/thromboembolic events; being an independent risk factor for major bleeding (HR 1.77, 95 % CI 1.07-2.92), and composite thrombotic/thromboembolic events (HR 1.55, 95 % CI 1.05-2.31). CONCLUSION: In this "real world" AF cohort, polypharmacy was highly prevalent and conditioned worse prognosis due to its association with bleeding and thromboembolic events.
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Martínez-Montesinos et al. (2022) conducted a cohort in Atrial fibrillation (n=1,050). Polypharmacy (≥ 5 concomitant drugs) vs. Non-polypharmacy (< 5 concomitant drugs) was evaluated on Major bleeding (HR 1.77, 95% CI 1.07-2.92). Polypharmacy in atrial fibrillation patients starting vitamin K antagonists was an independent risk factor for major bleeding (HR 1.77; 95% CI 1.07-2.92) and thromboembolic events.
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