TY - JOUR
T1 - Use and associated risks of concomitant aspirin therapy with oral anticoagulation in patients with atrial fibrillation insights from the outcomes registry for better informed treatment of atrial fibrillation (ORBIT-AF) registry
AU - Steinberg, Benjamin A.
AU - Kim, Sunghee
AU - Piccini, Jonathan P.
AU - Fonarow, Gregg C.
AU - Lopes, Renato D.
AU - Thomas, Laine
AU - Ezekowitz, Michael D.
AU - Ansell, Jack
AU - Kowey, Peter
AU - Singer, Daniel E.
AU - Gersh, Bernard
AU - Mahaffey, Kenneth W.
AU - Hylek, Elaine
AU - Go, Alan S.
AU - Chang, Paul
AU - Peterson, Eric D.
PY - 2013/8/13
Y1 - 2013/8/13
N2 - Background-The role of concomitant aspirin (ASA) therapy in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC) is unclear. We assessed concomitant ASA use and its association with clinical outcomes among AF patients treated with OAC. Methods and Results-The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry enrolled 10 126 AF patients from 176 US practices from June 2010 through August 2011. The study population was limited to those on OAC (n=7347). Hierarchical multivariable logistic regression models were used to assess factors associated with concomitant ASA therapy. Primary outcomes were 6-month bleeding, hospitalization, ischemic events, and mortality. Overall, 35% of AF patients (n=2543) on OAC also received ASA (OAC+ASA). Patients receiving OAC+ASA were more likely to be male (66% versus 53%; P>0.0001) and had more comorbid illness than those on OAC alone. More than one third of patients (39%) receiving OAC+ASA did not have a history of atherosclerotic disease, yet 17% had elevated Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) bleeding risk scores (=5). Major bleeding (adjusted hazard ratio, 1.53; 95% confidence interval, 1.20-1.96) and bleeding hospitalizations (adjusted hazard ratio, 1.52; 95% confidence interval, 1.17-1.97) were significantly higher in those on OAC+ASA compared with those on OAC alone. Rates of ischemic events were low. Conclusions-Patients with AF receiving OAC are often treated with concomitant ASA, even when they do not have cardiovascular disease. Use of OAC+ASA was associated with significantly increased risk for bleeding, emphasizing the need to carefully determine if and when the benefits of concomitant ASA outweigh the risks in AF patients already on OAC. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01165710.
AB - Background-The role of concomitant aspirin (ASA) therapy in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC) is unclear. We assessed concomitant ASA use and its association with clinical outcomes among AF patients treated with OAC. Methods and Results-The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry enrolled 10 126 AF patients from 176 US practices from June 2010 through August 2011. The study population was limited to those on OAC (n=7347). Hierarchical multivariable logistic regression models were used to assess factors associated with concomitant ASA therapy. Primary outcomes were 6-month bleeding, hospitalization, ischemic events, and mortality. Overall, 35% of AF patients (n=2543) on OAC also received ASA (OAC+ASA). Patients receiving OAC+ASA were more likely to be male (66% versus 53%; P>0.0001) and had more comorbid illness than those on OAC alone. More than one third of patients (39%) receiving OAC+ASA did not have a history of atherosclerotic disease, yet 17% had elevated Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) bleeding risk scores (=5). Major bleeding (adjusted hazard ratio, 1.53; 95% confidence interval, 1.20-1.96) and bleeding hospitalizations (adjusted hazard ratio, 1.52; 95% confidence interval, 1.17-1.97) were significantly higher in those on OAC+ASA compared with those on OAC alone. Rates of ischemic events were low. Conclusions-Patients with AF receiving OAC are often treated with concomitant ASA, even when they do not have cardiovascular disease. Use of OAC+ASA was associated with significantly increased risk for bleeding, emphasizing the need to carefully determine if and when the benefits of concomitant ASA outweigh the risks in AF patients already on OAC. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01165710.
KW - Anticoagulants
KW - Aspirin
KW - Atrial fibrillation
KW - Hemorrhage
KW - Outcome assessment (health care)
UR - http://www.scopus.com/inward/record.url?scp=84882242349&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84882242349&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.113.002927
DO - 10.1161/CIRCULATIONAHA.113.002927
M3 - Article
C2 - 23861512
AN - SCOPUS:84882242349
SN - 0009-7322
VL - 128
SP - 721
EP - 728
JO - Circulation
JF - Circulation
IS - 7
ER -