{"id":38756,"date":"2013-09-12T09:00:14","date_gmt":"2013-09-12T13:00:14","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=38756"},"modified":"2013-09-11T22:09:14","modified_gmt":"2013-09-12T02:09:14","slug":"aspirin-therapy-with-anticoagulation-in-patients-with-afib","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/09\/12\/aspirin-therapy-with-anticoagulation-in-patients-with-afib\/","title":{"rendered":"Aspirin Therapy with Anticoagulation in Patients with Afib?"},"content":{"rendered":"

CardioExchange’s<\/i>\u00a0John Ryan<\/a><\/i><\/b> interviews Benjamin Steinberg <\/b><\/a>about his group\u2019s <\/i>recent analysis of data from the ORBIT-AF registry on concomitant aspirin therapy with oral anticoagulation<\/i><\/a>.<\/i><\/p>\n

THE STUDY<\/b><\/p>\n

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.<\/p>\n

<\/b>THE INTERVIEW<\/b><\/p>\n

Ryan:<\/b> 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?<\/b><\/p>\n

Steinberg:<\/b> 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\u2019re 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.<\/p>\n

Ryan: Should aspirin in these patients be considered a medical error?<\/b><\/p>\n

Steinberg: <\/b>I\u2019m not sure we can say that \u2013 it\u2019s 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.<\/p>\n

Ryan: What action should occur as a result of your study?<\/b><\/p>\n

Steinberg: <\/b>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\u2019m 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\u2019re on other antithrombotic therapy.<\/p>\n

JOIN THE DISCUSSION<\/b><\/p>\n

Will the findings of the ORBIT-AF analysis affect how you approach patients on long-term anticoagulation?<\/b><\/b><\/p>\n","protected":false},"excerpt":{"rendered":"

An interview with Benjamin Steinberg about an analysis of data from the ORBIT-AF registry, in which patients with atrial fibrillation who were taking oral anticoagulation and aspirin had a higher risk of bleeding than patients on anticoagulation only.<\/p>\n","protected":false},"author":301,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[495],"tags":[492,463,364,341,639],"class_list":["post-38756","post","type-post","status-publish","format-standard","hentry","category-anticoagulation-2","tag-anticoagulation","tag-antiplatelet-therapy","tag-aspirin","tag-atrial-fibrillation","tag-registries"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/38756","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/301"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=38756"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/38756\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=38756"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=38756"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=38756"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}