Anticoagulation and antiplatelet therapy in stable coronary artery disease: A multicenter survey

Kopin, David; Jones, W. Schuyler; Klein, Andrew J.; Barnes, Geoffrey D.

doi:10.1016/j.thromres.2019.05.017

Cited by 2 publications

(6 citation statements)

References 7 publications

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“…First, in the primary prevention cases, the majority of respondents deprescribe aspirin in patients on concomitant OAC for AF or VTE. This is consistent with the findings from a similar survey study of 40 cardiologists by Kopin and colleagues, which found that 11.1% of them would use aspirin for primary prevention in a patient case on OAC for AF 20 . In stable CAD cases, the majority of respondents decided to continue aspirin; this is also consistent with the study by Kopin and colleagues, which found that the majority of cardiologists would use OAC plus aspirin in a patient case with AF and stable CAD 20 .…”

Section: Discussionsupporting

confidence: 92%

“…This is consistent with the findings from a similar survey study of 40 cardiologists by Kopin and colleagues, which found that 11.1% of them would use aspirin for primary prevention in a patient case on OAC for AF 20 . In stable CAD cases, the majority of respondents decided to continue aspirin; this is also consistent with the study by Kopin and colleagues, which found that the majority of cardiologists would use OAC plus aspirin in a patient case with AF and stable CAD 20 . However, this study's findings are in contrast with the weak or conditional recommendations from the 2018 CHEST guidelines and 2020 American Society of Hematology (ASH) guidelines, which suggest OAC monotherapy rather than with concomitant aspirin use 4,6 .…”

Section: Discussionsupporting

confidence: 92%

“…20 In stable CAD cases, the majority of respondents decided to continue aspirin; this is also consistent with the study by Kopin and colleagues, which found that the majority of cardiologists would use OAC plus aspirin in a patient case with AF and stable CAD. 20 However, this study's findings are in contrast with the weak or conditional recommendations from the 2018 CHEST guidelines and 2020 American Society of Hematology (ASH) guidelines, which suggest OAC monotherapy rather than with concomitant aspirin use. 4,6 This survey suggests that practices in antithrombotic therapy currently do not reflect the newer guideline recommendations, despite growing evidence that concomitant use of OAC and aspirin is associated with an increased risk of bleeding compared with OAC monotherapy.…”

Section: Discussionsupporting

confidence: 85%

“…One of this study's strengths is the sample size, which is larger than that in the study by Kopin and colleagues 20 It also surveyed clinicians of different professions and specialties. Additionally, it considered different indications of OAC and use of aspirin after percutaneous coronary intervention (PCI) or after CABG in different settings, such as stable angina or ACS 19 .…”

Section: Discussionmentioning

confidence: 98%

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Aspirin deprescribing in patients on oral anticoagulation for atrial fibrillation or venous thromboembolism: A national survey of clinician practices

Ou,

Pozzolano,

Datta

et al. 2023

J Am Coll Clin Pharm

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Introduction: Concomitant use of oral anticoagulation (OAC) and aspirin increases bleeding risk without decreasing thromboembolic events compared with OAC monotherapy. Weak guideline recommendations and limited data exist for deprescribing aspirin for primary prevention or stable coronary artery disease in patients already on OAC for atrial fibrillation (AF) or venous thromboembolism (VTE).Objectives: The objective of this study was to identify aspirin deprescribing practices among clinicians for patients on OAC for AF or VTE and concomitant aspirin for non-compelling reasons.Methods: A cross-sectional, national survey was electronically distributed to pharmacists and non-pharmacists (physicians, nurse practitioners, physician assistants). Co-primary end points were composite aspirin discontinuation rates in patients on OAC for AF or VTE in primary prevention and stable coronary artery disease (CAD) cases. Key secondary end points were clinician comfort level with deprescribing aspirin and availability of institutional protocols.Results: Three hundred four responses were included: 212 (69.7%) pharmacists and 92 (30.3%) non-pharmacists. Mean age of respondents was 35.4 years, and 37.4% male. In the primary prevention cases, pharmacists were more likely to discontinue aspirin than non-pharmacists (76.7% vs. 54.6%, p < 0.001). In the stable CAD cases, composite rates of aspirin discontinuation by pharmacists and non-pharmacists were similar (41.7% vs. 40.1%, p = 0.140). More pharmacists than non-pharmacists stated that their aspirin deprescribing decisions were independent of the type of OAC that was used (60.4% vs. 35.9%, p < 0.001). Pharmacists were more likely to discontinue aspirin after discussing with patients compared with non-pharmacists (62.7% vs. 47.8%, p = 0.017). 27.3% of clinicians reported having a protocol to deprescribe aspirin at their institution/clinic. Conclusion:There are variations in aspirin deprescribing practices among clinicians in patients on OAC for AF or VTE and without compelling indications for aspirin.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 98%

See 2 more Smart Citations

Aspirin deprescribing in patients on oral anticoagulation for atrial fibrillation or venous thromboembolism: A national survey of clinician practices

Ou,

Pozzolano,

Datta

et al. 2023

J Am Coll Clin Pharm

View full text Add to dashboard Cite

show abstract

“…21 Nevertheless, concurrent use of oral anticoagulation with aspirin for patients with AF and stable CAD remains common and will probably require further efforts to promote deprescribing, including rigorous evaluation of these deprescribing efforts. 23 Although the data on anticoagulation alone versus anticoagulation plus single antiplatelet therapy are limited for patients with stable CAD, there is more robust evidence that aspirin may have net clinical harm for primary prevention of atherosclerotic disease. 2 This is particularly true for patients taking chronic anticoagulant therapy but without a clear indication for concurrent antiplatelet treatment.…”

Section: Combined Anticoagulant-antiplatelet Use By Patients With Mulmentioning

confidence: 99%

Combining antiplatelet and anticoagulant therapy in cardiovascular disease

Barnes

2020

Hematology

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Up to 10% of the >3 million Americans with atrial fibrillation will experience an acute coronary syndrome or undergo percutaneous coronary intervention. Therefore, concurrent indications for multiple antithrombotic agents is a common clinical scenario. Although each helps reduce thrombotic risk, their combined use significantly increases the risk of major bleeding events, which can be life threatening. In the past 5 years, a number of randomized clinical trials have explored different combinations of anticoagulation plus antiplatelet agents aimed at minimizing bleeding risk while preserving low thrombotic event rates. In general, shorter courses with fewer antithrombotic agents have been found to be effective, particularly when direct oral anticoagulants are combined with clopidogrel. Combined use of very low-dose rivaroxaban plus aspirin has also demonstrated benefit in atherosclerotic diseases, including coronary and peripheral artery disease. Use of proton pump inhibitor therapy while patients are taking multiple antithrombotic agents has the potential to further reduce upper gastrointestinal bleeding risk in select populations. Applying this evidence to patients with multiple thrombotic conditions will help to avoid costly and life-threatening adverse medication events.

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Anticoagulation and antiplatelet therapy in stable coronary artery disease: A multicenter survey

Cited by 2 publications

References 7 publications

Aspirin deprescribing in patients on oral anticoagulation for atrial fibrillation or venous thromboembolism: A national survey of clinician practices

Aspirin deprescribing in patients on oral anticoagulation for atrial fibrillation or venous thromboembolism: A national survey of clinician practices

Combining antiplatelet and anticoagulant therapy in cardiovascular disease

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