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Published on: February 28, 2012
Patients with Atrial Fibrillation are Unlikely to Benefit from Aspirin Monotherapy
Nan Wang1, Qiqi Hou2, Shouling Wu3
1Catheterization Unit, Tangshan Gongren Hospital, Tangshan, People's Republic of China.
Insights
Aspirin monotherapy in atrial fibrillation (AF) patients did not lower ischemic event risk but increased bleeding risk. Aspirin (ASA) therapy is unlikely to benefit AF patients.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Aspirin (ASA) is a primary antiplatelet therapy for cardiovascular disease (CVD).
- Many atrial fibrillation (AF) patients use ASA, necessitating an understanding of its risks and benefits in this population.
Purpose of the Study:
- To investigate the association between ASA monotherapy and major adverse cardiac and cerebrovascular events (MACCE) in AF patients.
- To determine if ASA monotherapy reduces ischemic events or increases bleeding events in AF patients.
Main Methods:
- A community-based cohort of 850 AF patients was divided into ASA monotherapy (n=174) and non-ASA therapy (n=676) groups.
- Clinical endpoints included myocardial infarction (MI), ischemic stroke (IS), and hemorrhagic stroke (HS).
- Kaplan-Meier curves, Log rank tests, and Cox regression models were used to analyze MACCE risk.
Main Results:
- Over 7.2 years, ASA therapy was not associated with reduced MACCE or ischemic stroke (IS) risk.
- ASA monotherapy was significantly associated with an increased risk of hemorrhagic stroke (HS) (HR: 2.563, P=0.044).
- Cumulative incidence of MACCE was 19.88% for ASA vs. 17.27% for non-ASA (P=0.511).
Conclusions:
- ASA monotherapy does not reduce ischemic event risk in AF patients.
- ASA monotherapy is linked to a higher risk of bleeding events, specifically hemorrhagic stroke.
- AF patients are unlikely to gain benefit from aspirin monotherapy.
Background:
Aspirin (ASA), the mainstay antiplatelet treatment in patients with cardiovascular disease (CVD), has been received by a considerable number of AF patients. This study sought to examine the association between ASA monotherapy and the risk of major adverse cardiac and cerebrovascular events (MACCE) in patients with atrial fibrillation (AF).
Methods:
A total of 850 patients with AF were identified from a community-based Kailuan study. All patients were assigned to two groups according to their medicine history: an aspirin therapy group (ASA group) (n = 174), and a non-aspirin therapy group (non-ASA group) (n = 676). The clinical endpoints are MACCE, including myocardial infarction (MI), ischemic stroke (IS), and hemorrhagic stroke (HS). Incidence curves for MACCE were plotted using the Kaplan-Meier method, and the Log rank test was used to assess the differences in incidence rates. The hazard ratios (HR) and 95% confidence intervals (CI) for MACCE were analyzed using Cox proportional-hazards analysis regression models.
Results:
During the 7.2-year follow-up, 30 MACCE occurred in the ASA group, and 101 in the non-ASA group, with a cumulative incidence of 19.88% vs 17.27%, P = 0.511; 3 cases of MI occurred in the ASA group, and 18 cases in the non-ASA group, with a cumulative incidence of 1.78% vs 2.90%, P = 0.305. Twenty-seven cases of IS occurred in the ASA group, and 84 cases in the non-ASA group, with a cumulative incidence of 1.78% vs 2.90%, P = 0.305. Eight cases of HS occurred in the ASA group, and 13 cases in the non-ASA group, with a cumulative incidence of 5.01% vs 2.34%, P = 0.045. Multivariate regression analysis showed that ASA therapy was not associated with MACCE (HR: 1.130, 95% CI: 0.747-1.710, P = 0.562). In addition, ASA therapy was not associated with IS (HR: 1.309, 95% CI: 0.843-2.034, P = 0.231). However, ASA therapy was significantly associated with HS (HR: 2.563, 95% CI: 1.024-6.418, P = 0.044).
Conclusion:
ASA monotherapy is not associated with a lower risk of ischemic events, while significantly associated with a higher risk of bleeding events. Patients with AF are unlikely to benefit from aspirin monotherapy.
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