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Outcomes Associated With Oral Anticoagulants Plus Antiplatelets in Patients With Newly Diagnosed Atrial Fibrillation.

Fox, KAA; Velentgas, P; Camm, AJ; Bassand, J-P; Fitzmaurice, DA; Gersh, BJ; Goldhaber, SZ; Goto, S; Haas, S; Misselwitz, F; et al. Fox, KAA; Velentgas, P; Camm, AJ; Bassand, J-P; Fitzmaurice, DA; Gersh, BJ; Goldhaber, SZ; Goto, S; Haas, S; Misselwitz, F; Pieper, KS; Turpie, AGG; Verheugt, FWA; Dabrowski, E; Luo, K; Gibbs, L; Kakkar, AK; GARFIELD-AF Investigators (2020) Outcomes Associated With Oral Anticoagulants Plus Antiplatelets in Patients With Newly Diagnosed Atrial Fibrillation. JAMA Netw Open, 3 (2). e200107. ISSN 2574-3805 https://doi.org/10.1001/jamanetworkopen.2020.0107
SGUL Authors: Camm, Alan John

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Abstract

Importance: Patients with nonvalvular atrial fibrillation at risk of stroke should receive oral anticoagulants (OAC). However, approximately 1 in 8 patients in the Global Anticoagulant Registry in the Field (GARFIELD-AF) registry are treated with antiplatelet (AP) drugs in addition to OAC, with or without documented vascular disease or other indications for AP therapy. Objective: To investigate baseline characteristics and outcomes of patients who were prescribed OAC plus AP therapy vs OAC alone. Design, Setting, and Participants: Prospective cohort study of the GARFIELD-AF registry, an international, multicenter, observational study of adults aged 18 years and older with recently diagnosed nonvalvular atrial fibrillation and at least 1 risk factor for stroke enrolled between March 2010 and August 2016. Data were extracted for analysis in October 2017 and analyzed from April 2018 to June 2019. Exposure: Participants received either OAC plus AP or OAC alone. Main Outcomes and Measures: Clinical outcomes were measured over 3 and 12 months. Outcomes were adjusted for 40 covariates, including baseline conditions and medications. Results: A total of 24 436 patients (13 438 [55.0%] male; median [interquartile range] age, 71 [64-78] years) were analyzed. Among eligible patients, those receiving OAC plus AP therapy had a greater prevalence of cardiovascular indications for AP, including acute coronary syndromes (22.0% vs 4.3%), coronary artery disease (39.1% vs 9.8%), and carotid occlusive disease (4.8% vs 2.0%). Over 1 year, patients treated with OAC plus AP had significantly higher incidence rates of stroke (adjusted hazard ratio [aHR], 1.49; 95% CI, 1.01-2.20) and any bleeding event (aHR, 1.41; 95% CI, 1.17-1.70) than those treated with OAC alone. These patients did not show evidence of reduced all-cause mortality (aHR, 1.22; 95% CI, 0.98-1.51). Risk of acute coronary syndrome was not reduced in patients taking OAC plus AP compared with OAC alone (aHR, 1.16; 95% CI, 0.70-1.94). Patients treated with OAC plus AP also had higher rates of all clinical outcomes than those treated with OAC alone over the short term (3 months). Conclusions and Relevance: This study challenges the practice of coprescribing OAC plus AP unless there is a clear indication for adding AP to OAC therapy in newly diagnosed atrial fibrillation.

Item Type: Article
Additional Information: This is an open access article distributed under the terms of the CC-BY License. © 2020 Fox KAA et al. JAMA Network Open.
Keywords: GARFIELD-AF Investigators
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: JAMA Netw Open
ISSN: 2574-3805
Language: eng
Dates:
DateEvent
5 February 2020Published
26 February 2020Published Online
5 January 2020Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 32101311
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111723
Publisher's version: https://doi.org/10.1001/jamanetworkopen.2020.0107

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