Effect of concomitant antiplatelet therapy in patients with nonvalvular atrial fibrillation initiating non‐vitamin K antagonists

Abstract

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.

Efficacy and safety of direct oral anticoagulants with and without Aspirin: A systematic review and Meta-analysis

“… [6] In the study by Ruiz et al, concomitant ASA was associated with higher rates of bleeding with no benefits in terms of ischemic protection. [12] The findings of Davidson et al study aligns with the findings of the previous studies that demonstrate that concomitant use of ASA is associated with an increased risk of major bleeding. [13] Tinkham et al study showed non-significant results for major bleeding between DOAC + APT and DOAC monotherapy.…”

Safety of apixaban compared to warfarin in hemodialysis patients: Do antiplatelets make a difference?

“…As anticoagulant and antiplatelet drugs inhibit different phases of hemostasis, their association can theoretically result in an increased hemorrhagic tendency. Clinically, a retrospective analysis found that antiplatelet use was rare in non‐HD patients treated with DOACs for atrial fibrillation (145/2361 [6.1%]) and that concomitant use of antiplatelets and DOACs increased bleeding risk approximately 3.5‐fold at 3 months of follow‐up compared to apixaban alone 32 . Another large retrospective study of non‐HD patients reported a lower risk of major bleeding with concomitant DOAC‐antiplatelet use compared to warfarin‐antiplatelet (HR 0.68 [95% CI 0.51‐0.91]) 33 .…”