Findings from the GARFIELD-AF registry presented Aug. 28 at ESC Congress 2018 suggest combined oral anticoagulant and antiplatelet therapy is associated with worse outcomes than anticoagulation alone in newly diagnosed atrial fibrillation (AFib) patients, especially those without a clear indication for antiplatelet therapy.

Researchers analysed data from 25,815 patients with newly diagnosed AFib from 1,317 sites in 35 countries. Of these patients, 3,133 patients were prescribed antiplatelet and oral anticoagulant therapy for the first time and 22,682 were prescribed oral anticoagulants alone. Patients were followed up for a minimum of 12 months.

Data showed patients receiving oral anticoagulants and antiplatelets had a higher prevalence of coronary artery disease, acute coronary syndrome, and stroke. However, 56 percent of patients prescribed both drugs did not have coronary artery disease or peripheral artery disease. Researchers also noted increased risk of major bleeding, all-cause death and stroke in patients in the combined treatment group compared with those on oral anticoagulation alone.

When comparing treatment type and outcomes in patients with an indication for antiplatelet therapy vs. those with no indication, combined treatment was independently associated with increased risks of all-cause death and stroke (HR 1.65, 95 percent CI 1.02–2.65) in those without an indication. However, combined treatment was not harmful in those with an indication.

"These findings challenge the use of combined oral anticoagulant and antiplatelet therapy in patients with AFib, especially those without an indication for antiplatelet therapy," said Keith A. A. Fox, MB, CHB, FACC, principal investigator, University of Edinburgh, UK. However, he noted the findings only apply to full dose anticoagulation and said AFib patients without coronary artery disease or other forms of atherosclerosis who are taking both medications should consult their physicians."

Clinical Topics: Anticoagulation Management

Keywords: ESC18, ESC Congress, Prospective Studies, Anticoagulants, Registries

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