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The Rate of Clinical Outcomes in Atrial Fibrillation according to Antithrombotic Strategy: The COOL-AF Registry

Rungroj Krittayaphong1, Arjbordin Winijkul1, Komsing Methavigul2

  • 1Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Cardiovascular Therapeutics
|March 14, 2022
PubMed

Insights

For atrial fibrillation (AF) patients, oral anticoagulant (OAC) alone is safer than antiplatelet therapy alone. Combining OAC with antiplatelet increases death risk without improving stroke prevention.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Atrial fibrillation (AF) patients face risks of ischemic stroke, major bleeding, and death.
  • Antithrombotic therapy is essential for managing these risks in AF patients.

Purpose of the Study:

  • To compare the rates of ischemic stroke/transient ischemic attack (TIA), major bleeding, and death.
  • To evaluate outcomes among AF patients receiving oral anticoagulant (OAC) alone, antiplatelet therapy alone, or OAC plus antiplatelet therapy.

Main Methods:

  • Analysis of prospective data from the COOL-AF Registry, Thailand's largest nationwide AF registry.
  • Collection of clinical, laboratory, and medication data at baseline and during follow-up.
  • Tracking of clinical outcomes including ischemic stroke/TIA, major bleeding, and death.

Main Results:

  • In 3,148 AF patients (mean age 68.1 years, 57.7% male), median rates per 100 person-years were: ischemic stroke/TIA 1.49, major bleeding 2.29, death 3.89.
  • Antiplatelet therapy alone (18.5% of patients) significantly increased risks of ischemic stroke/TIA and death compared to OAC alone (71.7% of patients).
  • OAC plus antiplatelet therapy (9.8% of patients) significantly increased death risk compared to OAC alone, without additional stroke prevention benefit.

Conclusions:

  • Antiplatelet therapy alone is associated with increased risks of ischemic stroke/TIA and death in AF patients.
  • Combination therapy of OAC plus antiplatelet increases mortality risk without enhancing stroke prevention.
  • Antiplatelet monotherapy should be avoided in atrial fibrillation patients.
Abstract

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