Underuse of Oral Anticoagulants and Inappropriate Prescription of Antiplatelet Therapy in Older Inpatients with Atrial Fibrillation

Overview

Journal Drugs Aging

Specialties Geriatrics
Pharmacology

Date 2017 Jul 14

PMID 28702928

Citations 12

Authors

Lorette Averlant

Gregoire Ficheur

Laurie Ferret

Stephane Boule

Francois Puisieux

Michel Luyckx

Julien Soula

Alexandre Georges

Regis Beuscart

Emmanuel Chazard

Jean-Baptiste Beuscart

Affiliations

Soon will be listed here.

Abstract

Background: Several studies have shown that the prescription of antiplatelet therapy (APT) is associated with an increased risk of oral anticoagulant (OAC) underuse in patients aged 75 years and over with atrial fibrillation (AF). An associated atheromatous disease may be the underlying reason for APT prescription. The objective of the study was to determine whether the association between underuse of OAC and APT prescription was explained by the presence of an atheromatous disease.

Methods And Results: We performed a retrospective, observational, single-centre study between 2009 and 2013 based on administrative data. Patients aged 75 years and over with non-valvular AF were identified in a database of 72,090 hospital stays. Prescriptions of anti-thrombotic medications and their association with the presence of atheromatous disease were evaluated by the mean of a logistic regression. A total of 2034 hospital stays were included (mean age 84.3 ± 5.2 years). The overall prevalence of known atheromatous disease was 25.9%. OAC underuse was observed in 58.5% of the stays. In multivariable analysis, the prescription of an APT was associated with an increased risk of OAC underuse [odds ratio (OR) 6.85; 95% confidence interval (CI) 5.50-8.58], independently of the presence of a concomitant known atheromatous disease (OR 0.78; 95% CI 0.60-1.01). Among the 692 stays with APT monotherapy (34.0%), 232 (33.5%) displayed an atheromatous disease.

Conclusions: The underuse of OAC is associated with the prescription of APT in older patients with AF, regardless of the presence or absence of known atheromatous disease. Our results suggest that APT is often inappropriately prescribed instead of OAC.

Citing Articles

Prevalence of Cardio-Embolic Brain Complications in Permanent and Paroxysmal Atrial Fibrillation Patients.

Rosca C, Sharma A, Nisulescu D, Otiman G, Duda-Seiman D, Morariu S Healthcare (Basel). 2023; 11(2).

PMID: 36673543 PMC: 9858915. DOI: 10.3390/healthcare11020175.

Time trends in antithrombotic therapy prescription patterns: Real-world monocentric study in hospitalized patients with atrial fibrillation.

Abrignani M, Lombardo A, Braschi A, Renda N, Abrignani V, Lombardo R World J Cardiol. 2022; 14(11):576-598.

PMID: 36483763 PMC: 9724000. DOI: 10.4330/wjc.v14.i11.576.

Identifying risk patterns in older adults with atrial fibrillation by hierarchical cluster analysis: A retrospective approach based on the risk probability for clinical events.

Suzuki S, Yamashita T, Otsuka T, Arita T, Yagi N, Kishi M Int J Cardiol Heart Vasc. 2021; 37:100883.

PMID: 34632044 PMC: 8487977. DOI: 10.1016/j.ijcha.2021.100883.

Non-adherence to Thromboprophylaxis Guidelines in Atrial Fibrillation: A Narrative Review of the Extent of and Factors in Guideline Non-adherence.

Gebreyohannes E, Salter S, Chalmers L, Bereznicki L, Lee K Am J Cardiovasc Drugs. 2020; 21(4):419-433.

PMID: 33369718 DOI: 10.1007/s40256-020-00457-3.

The Characteristics of Patients With Possible Transient Ischemic Attack and Minor Stroke in the Hunter and Manning Valley Regions, Australia (the INSIST Study).

Tomari S, Magin P, Lasserson D, Quain D, Valderas J, Dewey H Front Neurol. 2020; 11:383.

PMID: 32670173 PMC: 7326044. DOI: 10.3389/fneur.2020.00383.

References

Hanon O, Assayag P, Belmin J, Collet J, Emeriau J, Fauchier L . Expert consensus of the French Society of Geriatrics and Gerontology and the French Society of Cardiology on the management of atrial fibrillation in elderly people. Arch Cardiovasc Dis. 2013; 106(5):303-23. DOI: 10.1016/j.acvd.2013.04.001. View

Olesen J, Lip G, Lindhardsen J, Lane D, Ahlehoff O, Hansen M . Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation: A net clinical benefit analysis using a 'real world' nationwide cohort study. Thromb Haemost. 2011; 106(4):739-49. DOI: 10.1160/TH11-05-0364. View

Marcucci M, Nobili A, Tettamanti M, Iorio A, Pasina L, Djade C . Joint use of cardio-embolic and bleeding risk scores in elderly patients with atrial fibrillation. Eur J Intern Med. 2013; 24(8):800-6. DOI: 10.1016/j.ejim.2013.08.697. View

Gage B, Yan Y, E Milligan P, Waterman A, Culverhouse R, Rich M . Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006; 151(3):713-9. DOI: 10.1016/j.ahj.2005.04.017. View

Kirchhof P, Ammentorp B, Darius H, De Caterina R, Le Heuzey J, Schilling R . Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events--European Registry in Atrial Fibrillation (PREFER in AF). Europace. 2013; 16(1):6-14. PMC: 3864758. DOI: 10.1093/europace/eut263. View

Tendera M, Aboyans V, Bartelink M, Baumgartner I, Clement D, Collet J . ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and.... Eur Heart J. 2011; 32(22):2851-906. DOI: 10.1093/eurheartj/ehr211. View

January C, Samuel Wann L, Alpert J, Calkins H, Cigarroa J, Cleveland Jr J . 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014; 64(21):e1-76. DOI: 10.1016/j.jacc.2014.03.022. View

van de Steeg-van Gompel C, Wensing M, Braspenning J, De Smet P . The usefulness of antiplatelet prescriptions for the identification of patients with atherothrombosis in primary care: a Dutch cross-sectional study. J Eval Clin Pract. 2011; 18(4):866-71. DOI: 10.1111/j.1365-2753.2011.01697.x. View

Fan J, Arruda-Olson A, Leibson C, Smith C, Liu G, Bailey K . Billing code algorithms to identify cases of peripheral artery disease from administrative data. J Am Med Inform Assoc. 2013; 20(e2):e349-54. PMC: 3861931. DOI: 10.1136/amiajnl-2013-001827. View

10.

Rothendler J, Rose A, Reisman J, Berlowitz D, Kazis L . Choices in the use of ICD-9 codes to identify stroke risk factors can affect the apparent population-level risk factor prevalence and distribution of CHADS2 scores. Am J Cardiovasc Dis. 2012; 2(3):184-91. PMC: 3427978. View

11.

Bahri O, Roca F, Lechani T, Druesne L, Jouanny P, Serot J . Underuse of oral anticoagulation for individuals with atrial fibrillation in a nursing home setting in France: comparisons of resident characteristics and physician attitude. J Am Geriatr Soc. 2015; 63(1):71-6. DOI: 10.1111/jgs.13200. View

12.

Forslund T, Wettermark B, Wandell P, von Euler M, Hasselstrom J, Hjemdahl P . Risks for stroke and bleeding with warfarin or aspirin treatment in patients with atrial fibrillation at different CHA(2)DS(2)VASc scores: experience from the Stockholm region. Eur J Clin Pharmacol. 2014; 70(12):1477-85. DOI: 10.1007/s00228-014-1739-1. View

13.

Wolff A, Shantsila E, Lip G, Lane D . Impact of advanced age on management and prognosis in atrial fibrillation: insights from a population-based study in general practice. Age Ageing. 2015; 44(5):874-8. DOI: 10.1093/ageing/afv071. View

14.

Deitelzweig S, Jing Y, Swindle J, Makenbaeva D . Reviewing a clinical decision aid for the selection of anticoagulation treatment in patients with nonvalvular atrial fibrillation: applications in a US managed care health plan database. Clin Ther. 2014; 36(11):1566-1573.e3. DOI: 10.1016/j.clinthera.2014.09.016. View

15.

Beuscart R, McNair P, Brender J . Patient safety through intelligent procedures in medication: the PSIP project. Stud Health Technol Inform. 2009; 148:6-13. View

16.

Gardner C, Rankin J, Geelhoed E, Nguyen M, Newman M, Cutlip D . Evaluation of long-term clinical and health service outcomes following coronary artery revascularisation in Western Australia (WACARP): a population-based cohort study protocol. BMJ Open. 2014; 4(10):e006337. PMC: 4187452. DOI: 10.1136/bmjopen-2014-006337. View

17.

Gage B, Waterman A, Shannon W, Boechler M, Rich M, Radford M . Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001; 285(22):2864-70. DOI: 10.1001/jama.285.22.2864. View

18.

. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted.... Eur J Prev Cardiol. 2012; 19(4):585-667. DOI: 10.1177/2047487312450228. View

19.

Margolis J, Barron J, Grochulski W . Health care resources and costs for treating peripheral artery disease in a managed care population: results from analysis of administrative claims data. J Manag Care Pharm. 2005; 11(9):727-34. PMC: 10438191. DOI: 10.18553/jmcp.2005.11.9.727. View

20.

Monesi L, Tettamanti M, Cortesi L, Baviera M, Marzona I, Avanzini F . Elevated risk of death and major cardiovascular events in subjects with newly diagnosed diabetes: findings from an administrative database. Nutr Metab Cardiovasc Dis. 2014; 24(3):263-70. DOI: 10.1016/j.numecd.2013.08.005. View