AF patients with intermediate-to-high-risk of stroke often prescribed aspirin instead of anticoagulants


More than one-in-three patients with atrial fibrillation with an intermediate-to-high-risk of stroke are prescribed aspirin instead of oral anticoagulants, despite guidelines recommending the use of oral anticoagulants for this group of patients, according to a study published in the Journal of the American College of Cardiology

Using data from the American College of Cardiology’s PINNACLE Registry, researchers looked at records from 210,380 patients with a CHADS2 score greater than or equal to two between January 2008 and December 2012. In a secondary analysis, the researchers assessed records from 294,642 patients with a comparable CHA2DS2-VASc score during the same timeframe. 

Results showed that among the CHADS2 group, 38% were treated with aspirin, and nearly 62% were treated with oral anticoagulants. Among the CHA2DS2-VASc group, 40% were treated with aspirin, while 60% were treated with oral anticoagulants.  

For both groups, atrial fibrillation patients who were prescribed aspirin were younger, had a lower body mass index, were more likely to be female, and were more likely to have another medical condition, including diabetes, hypertension, high cholesterol, coronary artery disease, prior heart attack, prior coronary artery bypass graft surgery or peripheral artery disease. Those prescribed oral anticoagulants were more likely to be male, have a higher body mass index, a history of a prior stroke or blood clot, or a history of congestive heart failure. 

Jonathan C Hsu, the study’s lead author and assistant clinical professor of medicine, cardiology and cardiac electrophysiology at the University of California, San Diego, USA, says cardiovascular specialists may be prescribing aspirin instead of oral anticoagulants because they have “the misperception that aspirin exhibits adequate efficacy compared to oral anticoagulants.” He also noted that men had a 6% greater likelihood of being prescribed anticoagulants despite the fact that women have an increased risk of stroke.

In an accompanying editorial, Sanjay Deshpande, medical director of electrophysiology at Columbia St Mary’s Hospital, in Milwaukee, USA, and L Samuel Wann, a cardiologist at Columbia St Mary’s Hospital, said that clinicians may not realise that aspirin puts patients at risk for bleeding with “virtually no protection from stroke.”

“It is concerning that the highly motivated, conscientious, and talented cardiologists working in quality-conscious institutions that contribute their data to the NCDR are not prescribing anti-coagulation in one-third of their qualifying patients, as defined by our guidelines,” the editorial authors write.