Key result
Concomitant antiplatelet therapy in patients with nonvalvular atrial fibrillation initiating NOACs was associated with a higher risk of major bleeding (HR 3.62; 95% CI 1.32-9.89; P=0.012).
Why the study?
Concomitant antiplatelet therapy with oral anticoagulation is common in atrial fibrillation, but information regarding its effect on outcomes in patients taking non-vitamin K antagonist oral anticoagulants is scarce.
Does concomitant antiplatelet therapy increase bleeding or reduce ischemic events in patients with nonvalvular atrial fibrillation initiating NOACs?
Cohort (n=2,361)
Yes
Does concomitant antiplatelet therapy increase bleeding or reduce ischemic events in patients with nonvalvular atrial fibrillation initiating NOACs?
In patients with nonvalvular atrial fibrillation initiating NOACs without a recent ischemic event, concomitant antiplatelet therapy significantly increases major bleeding risk without providing ischemic benefit.
Answers are grounded in this paper and cite their sources.
May support bleeding caution with antiplatelets plus NOACs in AF; leaves open causal inference and practice change pending RCTs.
BACKGROUND: Antiplatelet therapy (APT) use in combination with oral anticoagulation is common among patients with atrial fibrillation, but there is scarce information regarding its effect on outcomes in patients on non-vitamin K antagonist oral anticoagulants (NOAC). We aimed to evaluate the safety and efficacy of APT use in a 'real-world' cohort of nonvalvular atrial fibrillation (NVAF) patients initiating NOAC. DESIGN: We conducted a retrospective multicentre study including 2361 consecutive NVAF patients initiating NOAC between January 2013 and December 2016. Patients with an acute ischaemic event within the last 12 months (acute coronary syndrome, stroke or revascularization) were excluded. Patients were followed up, and all clinical events were recorded at 3 months. The primary outcome of the study was major bleeding, and the secondary outcomes were stroke, nonfatal myocardial infarction, intracranial bleeding and death. RESULTS: One hundred forty-five (6.1%) patients received concomitant APT, and aspirin was the more common (79%). At 3 months, 25 (1.1%) patients had major bleeding, 8 (0.3%) had nonfatal myocardial infarction, 7 (0.3%) had ischaemic stroke, and 40 (1.7%) died. After multivariate adjustment, concomitant APT was associated with higher risk for major bleeding (HR = 3.62, 95% CI 1.32-9.89; P = .012), but was not associated with a higher risk of other clinical outcomes. CONCLUSIONS: Concomitant APT use is uncommon among these patients and does not seem to be associated with lower rates of ischaemic events or death. However, there are signals for an increased risk of bleeding, which reinforces current guideline recommendations.
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Ruíz et al. (2019) conducted a cohort in nonvalvular atrial fibrillation (n=2,361). Concomitant antiplatelet therapy vs. No concomitant antiplatelet therapy was evaluated on major bleeding (HR 3.62, 95% CI 1.32-9.89, p=.012). Concomitant antiplatelet therapy in patients with nonvalvular atrial fibrillation initiating NOACs was associated with a higher risk of major bleeding (HR 3.62; 95% CI 1.32-9.89; P=0.012).
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