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Published on: February 26, 2013
Dual antithrombotic therapy and gastroprotection in atrial fibrillation: an observational primary care study
Charis Xuan Xie1, John Robson2, Crystal Williams2
1Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Insights
Nearly two-thirds of patients with atrial fibrillation (AF) on dual antithrombotic therapy (DAT) received prolonged treatment. Gastroprotection was suboptimal in one in six patients, indicating a need for improved management strategies in AF care.
Area of Science:
- Cardiology
- Pharmacology
- Primary Care Medicine
Background:
- Dual antithrombotic therapy (DAT) combining anticoagulants and antiplatelet agents is used in patients with atrial fibrillation (AF) and cardiovascular disease (CVD).
- Minimizing DAT duration and optimizing gastroprotection are crucial for reducing bleeding risks in these high-risk patients.
Purpose of the Study:
- To assess the prevalence and duration of DAT prescription in a large primary care cohort of patients with AF.
- To evaluate the utilization of gastroprotective therapies in conjunction with DAT for AF patients.
- To identify factors influencing DAT and gastroprotection prescribing patterns.
Main Methods:
- An observational study analyzed prescribing data from January 2020 to June 2021 for 1.2 million individuals across four east London clinical commissioning groups.
- Logistic regression models were employed to characterize factors associated with DAT prescription, prolonged DAT (>12 months), and gastroprotection use in patients with AF.
Main Results:
- Of 8881 AF patients, 4.7% received DAT. 65.9% of these were on DAT for over 12 months, and 84.4% received gastroprotection.
- Females and older individuals (≥75 years) were less likely to receive DAT. Pre-existing CVD and South Asian ethnicity were linked to increased gastroprotection.
- Gastroprotection prescription was associated with prolonged DAT use.
Conclusions:
- A significant proportion of AF patients on DAT receive prolonged therapy, with suboptimal gastroprotection in some cases.
- Prescribing patterns for DAT and gastroprotection vary based on patient demographics (sex, age) and comorbidities.
- Improvements in the duration of DAT and gastroprotection management are necessary for patients with AF.
Background:
Patients with both atrial fibrillation (AF) and cardiovascular disease (CVD) may receive dual antithrombotic therapy (DAT) with both an anticoagulant and ≥1 antiplatelet agents. Avoiding prolonged duration of DAT and use of gastroprotective therapies reduces bleeding risk.
Aim:
To describe the extent and duration of DAT and use of gastroprotection in a primary care cohort of patients with AF.
Design & Setting:
Observational study in 1.2 million people registered with GPs across four east London clinical commissioning groups (CCGs), covering prescribing from January 2020-June 2021.
Method:
In patients with AF, factors associated with DAT prescription, prolonged DAT prescription (>12 months), and gastroprotective prescription were characterised using logistic regression.
Results:
There were 8881 patients with AF, of whom 4.7% (n = 416) were on DAT. Of these, 65.9% (n = 274) were prescribed DAT for >12 months and 84.4% (n = 351) were prescribed concomitant gastroprotection. Independent of all other factors, females with AF were less likely to receive DAT than males (odds ratio [OR] 0.61, 95% confidence interval [CI] = 0.49 to 0.77). Similarly, older (aged ≥75 years) individuals (OR 0.79, 95% CI = 0.63 to 0.98) were less likely to receive DAT than younger patients. Among those with AF on DAT, pre-existing CVD (OR 3.33, 95% CI = 1.71 to 6.47) and South Asian ethnicity (OR 2.70, 95% CI = 1.15 to 6.32) were associated with increased gastroprotection prescriptions. Gastroprotection prescription (OR 1.80, 95% CI = 1.01 to 3.22) was associated with prolonged DAT prescription.
Conclusion:
Almost two-thirds of patients with AF on DAT were prescribed prolonged durations of therapy. Prescription of gastroprotection therapies was suboptimal in one in six patients. Treatment decisions varied by sex, age, ethnic group, and comorbidity. Duration of DAT and gastroprotection in patients with AF requires improvement.
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