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Inappropriate Combined Antiplatelet and Anticoagulant Therapy in Older Patients with Atrial Fibrillation: Trend over Time (2009–18)

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Abstract

Background and Objectives

Antiplatelet therapy, when prescribed in combination with anticoagulant therapy to older patients with atrial fibrillation and no recent cardiovascular event, is inappropriate and a reversible risk factor of major bleeding. We aimed to assess the trend over time of the prevalence of inappropriate combined antiplatelet and anticoagulant therapy and to determine its associated factors during the direct oral anticoagulant era.

Methods

This was a study of consecutive older patients (age ≥ 75 years) with atrial fibrillation, receiving anticoagulant therapy upon admission, and undergoing a comprehensive geriatric assessment during their first admission in a Belgian teaching hospital between 2009 and 2018. Antiplatelet therapy was considered inappropriate in the absence of a recent cardiovascular event. We studied the prevalence of inappropriate combined antiplatelet and anticoagulant therapy by 2-year periods and assessed its associated factors since the year 2013.

Results

Inappropriate combined antiplatelet and anticoagulant therapy was identified in 21% of the 654 patients (median age 84 years, 51% women), with a prevalence decreasing (p ≤ 0.01) from 25% (2009–10) to 14.8% (2017–18). Among the 469 patients recruited during the direct oral anticoagulant era, inappropriate combined antiplatelet and anticoagulant therapy (19%) was associated in a multivariable analysis with a history of stroke/transient ischemic attack (odds ratio 2.13, p = 0.007), anticoagulation with low-molecular-weight heparin (odds ratio 3.44, p = 0.015), and a history of vascular disease (odds ratio 5.68, p < 0.001).

Conclusions

While inappropriate combined antiplatelet and anticoagulant therapy has declined over the last decade, there is still room for improvement. Antiplatelet deprescribing should be considered in all patients with inappropriate combined antiplatelet and anticoagulant therapy, including those with vascular disease and no recent cardiovascular event.

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Acknowledgments

We thank Prof. Olivia Dalleur and Caroline Vandernabeele, clinical pharmacists at Cliniques Universitaires Saint Luc, Dr. Frédéric Maes, cardiologist at Cliniques Universitaires Saint Luc, and Dr. Aydine Hendi, student at Université Catholique de Louvain, for their work contributing to the database. We thank Alix Collard and Aline Van Maanen, statisticians at Cliniques Universitaires Saint Luc for their help during the review process.

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Authors and Affiliations

  1. Geriatric Medicine, Centre Hospitalier Universitaire Brugmann, 36, Rue du Foyer Schaerbeekois, 1030, Brussels, Belgium

    Emilie Philippe

  2. Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium

    Séverine Henrard

  3. Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium

    Séverine Henrard, Benoit Boland & Sophie Marien

  4. Geriatric Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium

    Benoit Boland & Sophie Marien

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  1. Emilie Philippe
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Corresponding author

Correspondence to Emilie Philippe.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflicts of Interest/Competing Interests

Emilie Philippe, Séverine Henrard, Benoit Boland, and Sophie Marien have no potential conflicts of interest that might be relevant to this work.

Ethics Approval

The study protocol was approved by the Comité d’Ethique Hospitalo-Facultaire, Cliniques Univeritaires Saint-Luc, Université Catholique de Louvain (reference 2018/14FEV/063, registration number B403).

Consent to Participate

Considering the signification proportion of deceased patients included in this study, related to its retrospective nature and the age and frailty of the cohort included, we elected not to ask for informed consent, so as not to cause undue distress to deceased patients’ families.

Consent for Publication

Not applicable.

Availability of Data and Material

The datasets that support the findings of this study are available from the corresponding author on reasonable request.

Code Availability

Not applicable.

Authors’ Contributions

All authors have made significant contributions to the study. EP, SH, and SM conceptualized and designed the study. EP, BB, and SM worked on the literature review and data collection. EP performed the initial analysis and interpretation of the data while SH performed the formal statistical analysis. EP and SM drafted the manuscript and all authors contributed to critically revising it. All the authors read and approved the final manuscript.

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Philippe, E., Henrard, S., Boland, B. et al. Inappropriate Combined Antiplatelet and Anticoagulant Therapy in Older Patients with Atrial Fibrillation: Trend over Time (2009–18). Drugs Aging 40, 273–283 (2023). https://doi.org/10.1007/s40266-023-01006-8

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