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STOPP/START Anti-aggregation and Anticoagulation Alerts in Atrial Fibrillation

Francesco Salis1, Antonella Palimodde1, Samuele Rundeddu1

  • 1Department of Medical Sciences, and Public Health, University of Cagliari, Cagliari, Italy.

Current Vascular Pharmacology
|April 18, 2023
PubMed
Abstract

Insights

In elderly patients with atrial fibrillation, oral anticoagulant therapy (OAT) did not impact mortality. The STOPP/START criteria help assess appropriate antithrombotic drug use in this population.

Area of Science:

  • Geriatric Medicine
  • Cardiology
  • Clinical Pharmacology

Background:

  • Atrial Fibrillation (AF) is a prevalent condition in the elderly population.
  • Oral Anticoagulant Therapy (OAT), including Vitamin K Antagonists (VKAs) and Direct Oral Anticoagulants (DOACs), is crucial for AF management.
  • Potential for inappropriate prescription or omission of OAT exists in elderly AF patients.

Purpose of the Study:

  • To evaluate the appropriateness of OAT prescription and omission in elderly AF patients using STOPP/START criteria.
  • To determine the impact of OAT on 36-month mortality in this cohort.
  • To assess the utility of STOPP/START criteria in optimizing antithrombotic therapy.

Main Methods:

  • A cohort of 427 nonvalvular AF patients was evaluated between 2013 and 2019.
  • Patients were divided into OAT (n=330) and non-OAT (n=97) groups.
  • The STOPP/START criteria were applied to assess drug prescription and omission, with a 36-month follow-up.

Main Results:

  • No significant difference in comorbidity burden, frailty, or cardio-cerebro-vascular disease prevalence between OAT and non-OAT groups.
  • Overall OAT prescription was appropriate, with 62.4% of the OAT group meeting START criteria for antiplatelets and STOPP criteria against their use due to concurrent anticoagulation.
  • In the non-OAT group, 69.1% met START criteria for anticoagulants and 21.6% for antiplatelets.
  • No statistically significant difference in 36-month mortality was observed between the groups (p = 0.97).

Conclusions:

  • Elderly patients with AF are susceptible to under- or over-prescription of antithrombotic drugs.
  • STOPP/START criteria serve as a valuable tool for identifying and rectifying inappropriate therapeutic choices.
  • In frail and comorbid individuals with AF, survival is not demonstrably linked to the use of OAT.
Keywords:
Atrial fibrillationSTOPP/START criteriacomorbiditiescomprehensive geriatric assessment (CGA)potential prescribing omission (PPO).potentially inappropriate medication (PIM)potentially prescribing omissionscreening tool of older persons’ prescriptions (STOPP)screening tool to alert to right treatment (START)

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