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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.

Publication ,  Journal Article
Steinberg, BA; Kim, S; Piccini, JP; Fonarow, GC; Lopes, RD; Thomas, L; Ezekowitz, MD; Ansell, J; Kowey, P; Singer, DE; Gersh, B; Mahaffey, KW ...
Published in: Circulation
August 13, 2013

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.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 13, 2013

Volume

128

Issue

7

Start / End Page

721 / 728

Location

United States

Related Subject Headings

  • beta-Alanine
  • Treatment Outcome
  • Ticlopidine
  • Risk
  • Registries
  • Prospective Studies
  • Platelet Aggregation Inhibitors
  • Myocardial Ischemia
  • Models, Cardiovascular
  • Middle Aged
 

Citation

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Steinberg, B. A., Kim, S., Piccini, J. P., Fonarow, G. C., Lopes, R. D., Thomas, L., … ORBIT-AF Investigators and Patients, . (2013). 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. Circulation, 128(7), 721–728. https://doi.org/10.1161/CIRCULATIONAHA.113.002927
Steinberg, Benjamin A., Sunghee Kim, Jonathan P. Piccini, Gregg C. Fonarow, Renato D. Lopes, Laine Thomas, Michael D. Ezekowitz, et al. “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.Circulation 128, no. 7 (August 13, 2013): 721–28. https://doi.org/10.1161/CIRCULATIONAHA.113.002927.
Steinberg BA, Kim S, Piccini JP, Fonarow GC, Lopes RD, Thomas L, Ezekowitz MD, Ansell J, Kowey P, Singer DE, Gersh B, Mahaffey KW, Hylek E, Go AS, Chang P, Peterson ED, ORBIT-AF Investigators and Patients. 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. Circulation. 2013 Aug 13;128(7):721–728.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 13, 2013

Volume

128

Issue

7

Start / End Page

721 / 728

Location

United States

Related Subject Headings

  • beta-Alanine
  • Treatment Outcome
  • Ticlopidine
  • Risk
  • Registries
  • Prospective Studies
  • Platelet Aggregation Inhibitors
  • Myocardial Ischemia
  • Models, Cardiovascular
  • Middle Aged