Raffaele De Caterina1, Bettina Ammentorp2, Harald Darius3, Jean-Yves Le Heuzey4, Giulia Renda5, Richard John Schilling6, Tessa Schliephacke2, Paul-Egbert Reimitz2, Josef Schmitt2, Christine Schober2, José Luis Zamorano7, Paulus Kirchhof8. 1. Institute of Cardiology and Center of Excellence on Aging, G. d'Annunzio, University Chieti-Pescara, Pisa, Italy Fondazione G. Monasterio, Pisa, Italy. 2. Daiichi Sankyo Europe, Munich, Germany. 3. Vivantes Hospital Neukölln, Berlin, Germany. 4. Cardiology and Arrhythmology, Georges Pompidou Hospital, René Descartes University, Paris, France. 5. Institute of Cardiology and Center of Excellence on Aging, G. d'Annunzio, University Chieti-Pescara, Pisa, Italy. 6. Barts and St Thomas Hospital, London, UK. 7. Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. 8. University of Birmingham Centre for Cardiovascular Sciences and SWBH NHS Trust, Birmingham, UK Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany.
Abstract
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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 AFpatients 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Gilles Lemesle; Gregory Ducrocq; Yedid Elbez; Eric Van Belle; Shinya Goto; Christopher P Cannon; Christophe Bauters; Deepak L Bhatt; Philippe Gabriel Steg Journal: Clin Cardiol Date: 2017-07-10 Impact factor: 2.882
Authors: Paulus Kirchhof; Sylvia Haas; Pierre Amarenco; Susanne Hess; Marc Lambelet; Martin van Eickels; Alexander G G Turpie; A John Camm Journal: J Am Heart Assoc Date: 2020-02-21 Impact factor: 5.501