title: Frequent and possibly inappropriate use of combination therapy with an oral anticoagulant and antiplatelet agents in patients with atrial fibrillation in Europe.
abstract: OBJECTIVE
  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.
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, G. d'Annunzio, University Chieti-Pescara, Pisa, Italy Fondazione G. Monasterio, Pisa, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caterina
authors.affiliation: Daiichi Sankyo Europe, Munich, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Ammentorp
authors.affiliation: Vivantes Hospital Neukölln, Berlin, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Darius
authors.affiliation: Cardiology and Arrhythmology, Georges Pompidou Hospital, René Descartes University, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Heuzey
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, G. d'Annunzio, University Chieti-Pescara, Pisa, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Renda
authors.affiliation: Barts and St Thomas Hospital, London, UK.
authors.forename: Richard John
authors.initials: RJ
authors.lastname: Schilling
authors.affiliation: Daiichi Sankyo Europe, Munich, Germany.
authors.forename: Tessa
authors.initials: T
authors.lastname: Schliephacke
authors.affiliation: Daiichi Sankyo Europe, Munich, Germany.
authors.forename: Paul-Egbert
authors.initials: PE
authors.lastname: Reimitz
authors.affiliation: Daiichi Sankyo Europe, Munich, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Schmitt
authors.affiliation: Daiichi Sankyo Europe, Munich, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Schober
authors.affiliation: Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences and SWBH NHS Trust, Birmingham, UK Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany.
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications*; D002318:Cardiovascular Diseases; D004359:Drug Therapy, Combination / Q000592:standards / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors