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Published on: February 26, 2013
Inappropriate Combined Antiplatelet and Anticoagulant Therapy in Older Patients with Atrial Fibrillation: Trend over
Emilie Philippe1, Séverine Henrard2,3, Benoit Boland3,4
1Geriatric Medicine, Centre Hospitalier Universitaire Brugmann, 36, Rue du Foyer Schaerbeekois, 1030, Brussels, Belgium. emilie.philippe@chu-brugmann.be.
Insights
Inappropriate combined antiplatelet and anticoagulant therapy in older atrial fibrillation patients decreased but remains a bleeding risk. Deprescribing antiplatelets is crucial, especially for those with vascular disease and no recent cardiovascular events.
Area of Science:
- Geriatric Medicine
- Cardiology
- Pharmacology
Background:
- Combined antiplatelet and anticoagulant therapy is often inappropriate for older atrial fibrillation patients without recent cardiovascular events.
- This combination increases the risk of major bleeding and is a reversible risk factor.
Purpose of the Study:
- To analyze the trend in inappropriate combined antiplatelet and anticoagulant therapy prevalence over time.
- To identify factors associated with this inappropriate therapy during the direct oral anticoagulant era.
Main Methods:
- A study of consecutive patients aged 75 years or older with atrial fibrillation, receiving anticoagulant therapy.
- Comprehensive geriatric assessment was performed during their first hospital admission (2009-2018).
- Prevalence was analyzed by 2-year periods, and associated factors were assessed since 2013.
Main Results:
- Inappropriate combined therapy was found in 21% of 654 patients, decreasing from 25% (2009-10) to 14.8% (2017-18).
- Among 469 patients in the direct oral anticoagulant era, 19% received inappropriate combined therapy.
- Associated factors included prior stroke/TIA, low-molecular-weight heparin use, and history of vascular disease.
Conclusions:
- Despite a decline, inappropriate combined antiplatelet and anticoagulant therapy persists in older atrial fibrillation patients.
- Antiplatelet deprescribing should be considered for all patients with inappropriate combinations, including those with vascular disease and no recent cardiovascular events.
Background And Objectives:
Antiplatelet therapy, when prescribed in combination with anticoagulant therapy to older patients with atrial fibrillation and no recent cardiovascular event, is inappropriate and a reversible risk factor of major bleeding. We aimed to assess the trend over time of the prevalence of inappropriate combined antiplatelet and anticoagulant therapy and to determine its associated factors during the direct oral anticoagulant era.
Methods:
This was a study of consecutive older patients (age ≥ 75 years) with atrial fibrillation, receiving anticoagulant therapy upon admission, and undergoing a comprehensive geriatric assessment during their first admission in a Belgian teaching hospital between 2009 and 2018. Antiplatelet therapy was considered inappropriate in the absence of a recent cardiovascular event. We studied the prevalence of inappropriate combined antiplatelet and anticoagulant therapy by 2-year periods and assessed its associated factors since the year 2013.
Results:
Inappropriate combined antiplatelet and anticoagulant therapy was identified in 21% of the 654 patients (median age 84 years, 51% women), with a prevalence decreasing (p ≤ 0.01) from 25% (2009-10) to 14.8% (2017-18). Among the 469 patients recruited during the direct oral anticoagulant era, inappropriate combined antiplatelet and anticoagulant therapy (19%) was associated in a multivariable analysis with a history of stroke/transient ischemic attack (odds ratio 2.13, p = 0.007), anticoagulation with low-molecular-weight heparin (odds ratio 3.44, p = 0.015), and a history of vascular disease (odds ratio 5.68, p < 0.001).
Conclusions:
While inappropriate combined antiplatelet and anticoagulant therapy has declined over the last decade, there is still room for improvement. Antiplatelet deprescribing should be considered in all patients with inappropriate combined antiplatelet and anticoagulant therapy, including those with vascular disease and no recent cardiovascular event.
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