Author + information
- Milan Gupta,
- Yan Yan Wu,
- Mahesh Kajil,
- Michelle Tsigoulis,
- Jafna Cox,
- Paul Dorian,
- Carl Fournier,
- David Gladstone,
- Evan Lockwood,
- G.B. John Mancini,
- Ashfaq Shuaib,
- Narendra Singh and
- Andrew Ha
Background: For patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC) for stroke prevention, concomitant use of antiplatelet (AP) agents increases bleeding risk without necessarily reducing ischemic vascular events. From a contemporary prospective registry, we sought to identify factors associated with OAC+AP vs. OAC use in a cohort of Canadian AF patients.
Methods: We enrolled 2,499 AF patients from 133 sites in Canada (Nov 2013 to March 2016) in a prospective observational registry. Here, we report on data from the first 2,215 patients enrolled. Demographics of patients treated with OAC+AP (primarily aspirin) vs. OAC alone were identified. Multivariable logistic regression with a backward selection algorithm was performed to identify factors associated with OAC+AP vs. OAC use.
Results: There were 1,795 (81%) OAC-treated patients and 288 (16%) of them were treated with concomitant AP. With bivariate logistic regression, patients treated with OAC+AP vs. OAC alone were similar in age (75.0±10.0 vs. 74.6±9.5 years, p=0.5) while those in the OAC+AP group were more likely to: be male, diabetic, have heart failure, stroke/TIA, or vascular disease (stable CAD, acute coronary syndrome, percutaneous coronary intervention, coronary artery bypass surgery, or peripheral vascular disease). On multivariable analysis, male sex (OR 1.4, 95% CI 1.1-1.9, P=0.02) and vascular disease (OR 3.8, 95% CI 2.9-4.9, P<0.01) were associated with higher odds of OAC+AP use. In the OAC+AP subgroup, 126 (44%) patients did not have a history of vascular disease.
Conclusions: In this contemporary AF registry, AP was co-prescribed in one sixth of OAC-treated patients. Vascular disease was strongly associated with higher odds of OAC+AP use. This suggests that the perceived incremental gain in vascular protection from AP use may outweigh the reality of bleeding when treatment decisions are made by physicians. In addition, there was a substantial proportion of patients without known vascular disease who were treated with OAC+AP, despite absence of a clear indication for AP use. These findings highlight the need to avoid AP over-prescription amongst OAC-treated patients in order to minimize bleeding.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation and VT: Specific Situations and Newer Outcome Measures
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1190-100
- 2017 American College of Cardiology Foundation