In the Journals

Anticoagulants prescribed more frequently in AF patients, underused in elderly

The use of oral anticoagulation in patients with atrial fibrillation has increased in the past decade, but antiplatelet therapy remains common in this population, recent study data suggest.

Notably, the researchers also found that oral anticoagulation may be underused in the elderly population, possibly due to concerns of bleeding risk.

The analysis of the baseline dataset of the EURO-AF pilot survey addressed antithrombotic therapy prescriptions, specifically focusing on the risk factors guiding treatment approaches. The study included 3,119 patients with AF, with enrollment between February 2012 and March 2013.

In cases where oral anticoagulation was prescribed to hospitalized patients not treated or scheduled for pharmacological or electrical cardioversion or catheter ablation, most were prescribed vitamin K antagonist therapy (72.2%), whereas 7.7% received novel oral anticoagulants.

No significant differences in bleeding risk factors were observed between patients treated on the different antithrombotic therapies, with the exception of patients with chronic kidney disease, for whom oral anticoagulation was less commonly used (P=.0318).

Prescription of antiplatelet therapy was more common among patients with HAS-BLED scores of 2 or higher (P<.0001). Researchers noted a link between female sex and increased use of oral anticoagulation therapy (P=.0245). Inverse associations were observed between novel oral anticoagulant use and valvular heart disease (P<.0001), chronic HF (P=.001), CAD (P<.0001) and peripheral arterial disease (P=.0092).

Combination therapy consisting of oral anticoagulation plus an antiplatelet drug was most often prescribed for CAD (OR=8.54; P<.0001). Other factors associated with the prescription of combination therapy included age, valvular heart disease, chronic HF, hypertension, PAD and diabetes (P<.0001 for all).

When prescription decisions were based upon CHA2DS2-VASc score, 95.6% of patients with a score of ≥1 received antithrombotic therapy, whereas 80.5% received oral anticoagulation. Among patients with a CHA2DS2-VASc score ≥2, 83.7% received antithrombotic therapy, and 70.9% of these patients received oral anticoagulation. For these participants, vitamin K antagonists were prescribed in 64.1% of cases, whereas novel oral anticoagulants were prescribed in 6.9%.

The researchers wrote that, particularly in elderly patients, oral anticoagulation appears to be underused. “There was a tendency [toward] younger patients being prescribed less oral anticoagulation and antiplatelet therapy alone being more commonly prescribed in the elderly,” the researchers wrote. “The evidence is clear that the risk of major bleeding with aspirin is not significantly different to oral anticoagulation, especially in the elderly.”

Disclosure: See the full study for a list of relevant financial disclosures. 

The use of oral anticoagulation in patients with atrial fibrillation has increased in the past decade, but antiplatelet therapy remains common in this population, recent study data suggest.

Notably, the researchers also found that oral anticoagulation may be underused in the elderly population, possibly due to concerns of bleeding risk.

The analysis of the baseline dataset of the EURO-AF pilot survey addressed antithrombotic therapy prescriptions, specifically focusing on the risk factors guiding treatment approaches. The study included 3,119 patients with AF, with enrollment between February 2012 and March 2013.

In cases where oral anticoagulation was prescribed to hospitalized patients not treated or scheduled for pharmacological or electrical cardioversion or catheter ablation, most were prescribed vitamin K antagonist therapy (72.2%), whereas 7.7% received novel oral anticoagulants.

No significant differences in bleeding risk factors were observed between patients treated on the different antithrombotic therapies, with the exception of patients with chronic kidney disease, for whom oral anticoagulation was less commonly used (P=.0318).

Prescription of antiplatelet therapy was more common among patients with HAS-BLED scores of 2 or higher (P<.0001). Researchers noted a link between female sex and increased use of oral anticoagulation therapy (P=.0245). Inverse associations were observed between novel oral anticoagulant use and valvular heart disease (P<.0001), chronic HF (P=.001), CAD (P<.0001) and peripheral arterial disease (P=.0092).

Combination therapy consisting of oral anticoagulation plus an antiplatelet drug was most often prescribed for CAD (OR=8.54; P<.0001). Other factors associated with the prescription of combination therapy included age, valvular heart disease, chronic HF, hypertension, PAD and diabetes (P<.0001 for all).

When prescription decisions were based upon CHA2DS2-VASc score, 95.6% of patients with a score of ≥1 received antithrombotic therapy, whereas 80.5% received oral anticoagulation. Among patients with a CHA2DS2-VASc score ≥2, 83.7% received antithrombotic therapy, and 70.9% of these patients received oral anticoagulation. For these participants, vitamin K antagonists were prescribed in 64.1% of cases, whereas novel oral anticoagulants were prescribed in 6.9%.

The researchers wrote that, particularly in elderly patients, oral anticoagulation appears to be underused. “There was a tendency [toward] younger patients being prescribed less oral anticoagulation and antiplatelet therapy alone being more commonly prescribed in the elderly,” the researchers wrote. “The evidence is clear that the risk of major bleeding with aspirin is not significantly different to oral anticoagulation, especially in the elderly.”

Disclosure: See the full study for a list of relevant financial disclosures. 

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