title: Inappropriate combination of warfarin and aspirin.
abstract: OBJECTIVE
  A combination of warfarin and aspirin is associated with increased bleeding compared with warfarin monotherapy. The aim of the study was to investigate the incidence and appropriateness of the combination of warfarin and aspirin in patients with atrial fibrillation (AF) or mechanical heart valve (MHV).
  
  
  METHODS
  This cross-sectional study included consecutive patients with AF or MHV on chronic warfarin therapy (>3 months) without acute coronary syndrome or have not undergone a revascularization procedure in the preceding year. Medical history, concomitant diseases, and treatment data were acquired through patient interviews and from hospital records.
  
  
  RESULTS
  Three hundred and sixty patients (213 with AF, 147 with MHV) were included. In those with AF, a significantly higher warfarin-aspirin combination was observed with concomitant vascular disease (38.8% vs. 14.6%), diabetes (36.6% vs. 16.3%), statin therapy (40% vs. 16.9%), left ventricular systolic dysfunction (33.3% vs. 17.5%) (p<0.05 for all). The use of combination therapy was similar between different CHADS-VASc scores. In patients with MHV, higher combination therapy was observed in males (41% vs. 26.7% in females; p=0.070), concomitant vascular disease (47.8% vs. 29.8%; p=0.091), and AF (56.3% vs. 29.8%; p=0.033). Independent predictors of warfarin-aspirin combination were concomitant vascular disease, diabetes, and (younger) age in patients with AF and were concomitant AF and male sex in patients with MHV. Interestingly, the incidence of combination therapy was found to increase with a higher HAS-BLED score in both patients with AF and MHV (p<0.001).
  
  
  CONCLUSIONS
  The combination of warfarin and aspirin was found to be prescribed to patients with AF mainly for the prevention of cardiovascular events, for which warfarin monotherapy usually suffices. On the other hand, co-treatment with aspirin appeared to be underused in patients with MHV.
authors.affiliation: Department of Cardiology, Kocaeli Derince Training and Research Hospital; Kocaeli-Turkey. drburakturan@gmail.com.
authors.forename: Burak
authors.initials: B
authors.lastname: Turan
authors.forename: Hakan
authors.initials: H
authors.lastname: Demir
authors.forename: Ayhan
authors.initials: A
authors.lastname: Mutlu
authors.forename: Tolga
authors.initials: T
authors.lastname: Daşlı
authors.forename: Ayhan
authors.initials: A
authors.lastname: Erkol
authors.forename: İsmail
authors.initials: İ
authors.lastname: Erden
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D001281:Atrial Fibrillation; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D013923:Thromboembolism / Q000517:prevention & control*; D014421:Turkey; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D001241:Aspirin