Study warns against combined use of oral anticoagulants, antiplatelet therapy for AFib
Combining oral anticoagulants with antiplatelet therapy in atrial fibrillation patients could be more than just overkill, University of Edinburgh researchers reported at the European Society of Cardiology (ESC)’s annual meeting this month—it could be dangerous, increasing the risk for all-cause death, stroke and major bleeding events in those without an indication for dual treatment.
Anticoagulants and antiplatelets are both critical to treating cardiovascular events since they’re both antithrombotics, principal investigator Keith Fox, MBBS, said in an ESC release, but that doesn’t mean they mesh well. Though the majority of AFib patients will be prescribed anticoagulants shortly after their diagnosis to circumvent stroke, adding an antiplatelet like aspirin to that regimen could encourage major bleeding.
In some cases, Fox said, like when a patient’s had a stent put in, survived a heart attack or presents with peripheral artery disease, the addition of antiplatelets might be appropriate. Still, it’s unknown how patients without an indication for them would react to preventive doses.
Fox and his colleagues pulled data from the GARFIELD-AF registry, which enrolled 25,815 patients recently diagnosed with atrial fibrillation across 35 countries, for their analysis, noting who had an indication for dual treatment. More than 3,000 patients were selected to receive anticoagulants plus antiplatelet therapy, while the remaining 22,000 participants took anticoagulants alone.
Patients who received oral anticoagulants plus antiplatelet therapy saw higher rates of coronary artery disease, acute coronary syndrome and stroke, Fox said. But 56 percent of them also lacked a clear indication for dual therapy in the form of coronary or peripheral artery disease.
“Combined oral anticoagulant and antiplatelet therapy was harmful in patients without an indication for antiplatelets,” Fox said. “In those with an indication, it was not harmful, but there did not appear to be any benefit. The results question the use of combined treatment in any patient with atrial fibrillation, but particularly in those without an indication for antiplatelets.”
He said combined treatment was independently associated with increased risks for all-cause death and stroke in patients without an indication for dual therapy. It was also linked the possibility of major bleeding.
“These findings challenge the use of combined oral anticoagulant and antiplatelet therapy in patients with atrial fibrillation,” Fox said. “More than half of patients prescribed both drugs did not have coronary artery disease or peripheral artery disease, suggesting that they did not have a clear indication for antiplatelet therapy. Patients with atrial fibrillation yet neither coronary artery disease nor other forms of atherosclerosis receiving both medications should consult their doctor.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.