September 12th, 2013

Aspirin Therapy with Anticoagulation in Patients with Afib?


CardioExchange’s John Ryan interviews Benjamin Steinberg about his group’s recent analysis of data from the ORBIT-AF registry on concomitant aspirin therapy with oral anticoagulation.


The investigators assessed concomitant aspirin use and its association with clinical outcomes among the >7000 patients in the ORBIT-AF registry who received oral anticoagulation. Thirty-five percent of patients received concomitant aspirin. At 6 months, these patients had significantly higher rates of major bleeding (adjusted hazard ratio, 1.53) and bleeding-related hospitalization (adjusted HR, 1.52) than patients on anticoaguation alone. Rates of ischemic events were low in both groups.


Ryan: You studied 7347 outpatients with atrial fibrillation who were taking oral anticoagulation and found that 35% were also taking aspirin. Of those patients on the combination treatment, 39% did not have atherosclerotic disease, and 17% had an elevated risk of bleeding. Have you revealed a large group of patients who are being overtreated?

Steinberg: I think we highlighted a large group of patients where the utility of aspirin should be considered very carefully. In patients without manifest atherosclerotic disease, the benefits of aspirin primary prevention are less robust. Furthermore, I think generally we’re more aware that long-term aspirin is not an entirely benign therapy and does carry risk. This point is probably accentuated in patients taking concomitant oral anticoagulation.

Ryan: Should aspirin in these patients be considered a medical error?

Steinberg: I’m not sure we can say that – it’s a judgment call for the physician. What we tried to do was highlight the use of dual therapy in patients that may not warrant it, and provide a glimpse of the potential risks of such an approach.

Ryan: What action should occur as a result of your study?

Steinberg: I think we as providers need to look very closely at our patients on long-term anticoagulation who are also taking long-term antiplatelet therapy (or may be taking it over the counter unbeknownst to us). I’m now much more attuned to patients taking aspirin without a convincing indication. When possible, I try to restrict aspirin use to patients who have a clear reason to be on it, particularly if they’re on other antithrombotic therapy.


Will the findings of the ORBIT-AF analysis affect how you approach patients on long-term anticoagulation?

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