Key result
In patients with atrial fibrillation, antiplatelet monotherapy had a similar risk for ischemic stroke compared with warfarin (RR 1.05) but a significantly lower risk of bleeding (RR 0.59).
Why the study?
Does antiplatelet therapy or combination therapy alter the risk of bleeding and stroke compared to warfarin monotherapy in Asian patients with atrial fibrillation?
Cohort (n=10,384)
Does antiplatelet therapy or combination therapy alter the risk of bleeding and stroke compared to warfarin monotherapy in Asian patients with atrial fibrillation?
Relative Risk: 1.05 (95% CI 0.89–1.25)
Absolute Event Rate: 41.15% vs 37.29%
p-value: p=0.50
In a Taiwanese AF cohort, antiplatelet therapy showed similar ischemic stroke risk but lower bleeding risk compared to warfarin, likely reflecting poor real-world anticoagulation control (low TTR) in this population.
Antiplatelet monotherapy may warrant consideration in Asian AF with low TTR; leaves open comparison to optimized warfarin.
BACKGROUND: Data on the use of oral anticoagulation (OAC) and antiplatelet therapy and the risk of bleeding and stroke amongst Asian patients with atrial fibrillation (AF) are limited. We investigated the risks of bleeding and stroke with use of oral anticoagulation (OAC) and antiplatelet therapy as mono- or combination therapy, in patients with AF from a Chinese nationwide cohort study. METHODS: We studied a cohort of 10384 patients (57.2% men, age 67.8 ± 13.2 yrs) between 1999 and 2010 from the National Health Insurance Research Database in Taiwan. Records of prescriptions were obtained during follow-up. The main outcome was a recurrent stroke during the follow-up period. Time-dependent Cox proportional hazards models were used for this analysis. RESULTS: We documented 1009 events for bleeding, as well as 224 hemorrhagic stroke and 1642 ischemic stroke events during a median 3.2 (interquartile range, 1.05-6.54) years' follow-up. Compared with warfarin users, patients with antiplatelet therapy had a lower risk of bleeding (adjusted relative risk [RR], 0.59, 95% confidence interval [CI], 0.49-0.71, p<0.001) whilst combination therapy had a non-statistically significant higher bleeding risk (RR, 1.33, 95%, 0.91-1.94, p = 0.20). Patients on antiplatelet monotherapy had a similar risk for ischemic stroke compared with OAC (RR 1.05, 95% CI, 0.89-1.25, p = 0.50), whilst those on combination therapy had a significantly higher risk (RR 1.90, 95% CI, 1.34-2.70, p<0.001). CONCLUSION: In a national representative cohort, antiplatelet therapy had no significant difference in ischemic stroke risk to warfarin. For bleeding, aspirin had a lower risk compared to warfarin. This may reflect poor anticoagulation control, highlighting important missed opportunities for improved stroke prevention, especially in countries where anticoagulation management is suboptimal.
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Chen et al. (2015) conducted a cohort in Atrial Fibrillation (n=10,384). Antiplatelet therapy vs. Warfarin was evaluated on Ischemic stroke (RR 1.05, 95% CI 0.89-1.25, p=0.50). In patients with atrial fibrillation, antiplatelet monotherapy had a similar risk for ischemic stroke compared with warfarin (RR 1.05) but a significantly lower risk of bleeding (RR 0.59).
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