Key result
Among 7,243 European patients with atrial fibrillation, 10.9% received combined OAC and antiplatelet therapy, of which 95.3% on dual and 63.8% on triple therapy lacked an accepted indication.
Why the study?
What is the frequency and appropriateness of combined oral anticoagulant and antiplatelet therapy in European patients with atrial fibrillation?
Observational (n=7,243)
Yes
What is the frequency and appropriateness of combined oral anticoagulant and antiplatelet therapy in European patients with atrial fibrillation?
Answers are grounded in this paper and cite their sources.
Combined OAC and antiplatelet therapy is frequently prescribed inappropriately in European AF patients, largely driven by coexisting coronary or peripheral arterial disease rather than guideline indications.
PURPOSE: Combined oral anticoagulant (OAC) and antiplatelet (AP) therapy is generally discouraged in atrial fibrillation (AF) outside of acute coronary syndromes or stenting because of increased bleeding. We evaluated its frequency and possible reasons in a contemporary European AF population. METHODS: The PREvention oF thromboembolic events-European Registry in Atrial Fibrillation (PREFER in AF) prospectively enrolled AF patients in France, Germany, Austria, Switzerland, Italy, Spain and the UK from January 2012 to January 2013. We evaluated patterns of combined VKA-AP therapy in this population. RESULTS: Out of 7243 patients enrolled, 5170 (71.4%) were treated with OAC alone, 808 (11.2%) with AP alone and 791 (10.9%) with a combination of OAC and one (dual) or two AP (triple combination therapy). Compared with patients only prescribed OAC, patients on combination treatment had similar Body Mass Index, but more frequently diabetes (p<0.05), dyslipidaemia (p<0.01), coronary heart disease (54.2 vs 18.6%; p<0.01) or peripheral arterial disease (10.2 vs 3.7%; p<0.01). Accordingly, they had a higher mean CHA2DS2VASc (3.7 vs 3.4), and HAS-BLED (2.7 vs 1.9) scores (for both, p<0.01). Of the 660 patients on dual AP+OAC combination therapy, 629 (95.3%) did not have an accepted indication. Out of the 105 patients receiving triple combination therapy, 67 (63.8%) did not have an accepted indication. CONCLUSIONS: The combined use of OAC and AP therapy is not uncommon in AF, largely inappropriate, explained by the coexistence of coronary or peripheral arterial disease, and not influenced by considerations on the risk of bleeding.
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Caterina et al. (2014) conducted an observational in Atrial fibrillation (n=7,243). Combined oral anticoagulant and antiplatelet therapy vs. Oral anticoagulant alone was evaluated on Frequency of combined OAC and AP therapy. Among 7,243 European patients with atrial fibrillation, 10.9% received combined OAC and antiplatelet therapy, of which 95.3% on dual and 63.8% on triple therapy lacked an accepted indication.
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