PMID- 25106421
OWN - NLM
STAT- MEDLINE
DCOM- 20150122
LR  - 20181202
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 100
IP  - 20
DP  - 2014 Oct
TI  - Frequent and possibly inappropriate use of combination therapy with an oral 
      anticoagulant and antiplatelet agents in patients with atrial fibrillation in 
      Europe.
PG  - 1625-35
LID - 10.1136/heartjnl-2014-305486 [doi]
AB  - PURPOSE: Combined oral anticoagulant (OAC) and antiplatelet (AP) therapy is 
      generally discouraged in atrial fibrillation (AF) outside of acute coronary 
      syndromes or stenting because of increased bleeding. We evaluated its frequency 
      and possible reasons in a contemporary European AF population. METHODS: The 
      PREvention oF thromboembolic events-European Registry in Atrial Fibrillation 
      (PREFER in AF) prospectively enrolled AF patients in France, Germany, Austria, 
      Switzerland, Italy, Spain and the UK from January 2012 to January 2013. We 
      evaluated patterns of combined VKA-AP therapy in this population. RESULTS: Out of 
      7243 patients enrolled, 5170 (71.4%) were treated with OAC alone, 808 (11.2%) 
      with AP alone and 791 (10.9%) with a combination of OAC and one (dual) or two AP 
      (triple combination therapy). Compared with patients only prescribed OAC, 
      patients on combination treatment had similar Body Mass Index, but more 
      frequently diabetes (p<0.05), dyslipidaemia (p<0.01), coronary heart disease 
      (54.2 vs 18.6%; p<0.01) or peripheral arterial disease (10.2 vs 3.7%; p<0.01). 
      Accordingly, they had a higher mean CHA2DS2VASc (3.7 vs 3.4), and HAS-BLED (2.7 
      vs 1.9) scores (for both, p<0.01). Of the 660 patients on dual AP+OAC combination 
      therapy, 629 (95.3%) did not have an accepted indication. Out of the 105 patients 
      receiving triple combination therapy, 67 (63.8%) did not have an accepted 
      indication. CONCLUSIONS: The combined use of OAC and AP therapy is not uncommon 
      in AF, largely inappropriate, explained by the coexistence of coronary or 
      peripheral arterial disease, and not influenced by considerations on the risk of 
      bleeding.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not 
      already granted under a licence) please go to 
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - De Caterina, Raffaele
AU  - De Caterina R
AD  - Institute of Cardiology and Center of Excellence on Aging, G. d'Annunzio, 
      University Chieti-Pescara, Pisa, Italy Fondazione G. Monasterio, Pisa, Italy.
FAU - Ammentorp, Bettina
AU  - Ammentorp B
AD  - Daiichi Sankyo Europe, Munich, Germany.
FAU - Darius, Harald
AU  - Darius H
AD  - Vivantes Hospital Neukolln, Berlin, Germany.
FAU - Le Heuzey, Jean-Yves
AU  - Le Heuzey JY
AD  - Cardiology and Arrhythmology, Georges Pompidou Hospital, Rene Descartes 
      University, Paris, France.
FAU - Renda, Giulia
AU  - Renda G
AD  - Institute of Cardiology and Center of Excellence on Aging, G. d'Annunzio, 
      University Chieti-Pescara, Pisa, Italy.
FAU - Schilling, Richard John
AU  - Schilling RJ
AD  - Barts and St Thomas Hospital, London, UK.
FAU - Schliephacke, Tessa
AU  - Schliephacke T
AD  - Daiichi Sankyo Europe, Munich, Germany.
FAU - Reimitz, Paul-Egbert
AU  - Reimitz PE
AD  - Daiichi Sankyo Europe, Munich, Germany.
FAU - Schmitt, Josef
AU  - Schmitt J
AD  - Daiichi Sankyo Europe, Munich, Germany.
FAU - Schober, Christine
AU  - Schober C
AD  - Daiichi Sankyo Europe, Munich, Germany.
FAU - Zamorano, Jose Luis
AU  - Zamorano JL
AD  - Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.
FAU - Kirchhof, Paulus
AU  - Kirchhof P
AD  - University of Birmingham Centre for Cardiovascular Sciences and SWBH NHS Trust, 
      Birmingham, UK Department of Cardiovascular Medicine, Hospital of the University 
      of Munster, Munster, Germany.
CN  - PREFER in AF Registry Investigators
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140808
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
CIN - Heart. 2014 Oct;100(20):1565-6. PMID: 25143367
MH  - Aged
MH  - Anticoagulants/*administration & dosage
MH  - Atrial Fibrillation/*complications
MH  - Cardiovascular Diseases
MH  - Drug Therapy, Combination/standards/statistics & numerical data
MH  - Europe
MH  - Female
MH  - Humans
MH  - Inappropriate Prescribing/*statistics & numerical data
MH  - Male
MH  - Platelet Aggregation Inhibitors/*administration & dosage
MH  - Prospective Studies
MH  - Thromboembolism/*etiology/*prevention & control
EDAT- 2014/08/12 06:00
MHDA- 2015/01/23 06:00
CRDT- 2014/08/10 06:00
PHST- 2014/08/10 06:00 [entrez]
PHST- 2014/08/12 06:00 [pubmed]
PHST- 2015/01/23 06:00 [medline]
AID - heartjnl-2014-305486 [pii]
AID - 10.1136/heartjnl-2014-305486 [doi]
PST - ppublish
SO  - Heart. 2014 Oct;100(20):1625-35. doi: 10.1136/heartjnl-2014-305486. Epub 2014 Aug 
      8.