AHA 2018: Study finds lower risk of bleeding in adults with AF and vascular disease taking DOACs versus warfarin

November 11, 2017 – Despite evidence that DOACs can help with bleeding in patients with atrial fibrillation, the researchers cautioned that more research is needed.

Treatment patterns and outcomes for patients with vascular disease and atrial fibrillation (AF) are not well characterized, adding complexity to treatment decisions for this population. A DCRI study found that although direct-acting oral anticoagulants (DOACs) may reduce the risk of bleeding events in patients with new-onset AF and vascular disease, the use of antiplatelet therapy in this population may need further review.

Results from the study were presented Sunday at the 2018 American Heart Association (AHA) Scientific Sessions in Chicago, Illinois.

Taku InoharaAccording to the analysis, DOACs such as apixaban, dabigatran, edoxaban, and rivaroxaban have been increasingly used, along with concomitant use of antiplatelet therapy, to manage this patient population. But the study found that antiplatelet agents, and particularly dual antiplatelet therapy (DAPT), seem to increase bleeding risk with no apparent clinical benefit to the patients. 

The retrospective cohort study set out to analyze treatment and outcomes in 6,203 patients from 229 sites with new-onset AF from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II) registry. In total, the registry enrolled 13,394 patients with AF at 244 sites from February 2013 to July 2016. In the new-onset AF cohort, vascular disease was associated with increased risk of major adverse cardiovascular or neurological events, cardiovascular death, and heart attack, also called a myocardial infarction, but not thromboembolic (involving a blood clot) or bleeding events.

“Relative to new onset-AF patients with vascular disease on warfarin, the rate of bleeding events appeared to be lower in those treated with DOACs, with similar efficacy,” said lead author and presenter Taku Inohara, MD, PhD, of the DCRI. “For these patients, DOACs may be preferable to warfarin.”

“Concomitant use of antiplatelet agents, especially DAPT, needs to be reconsidered, due to the increased risk of bleeding, without evidence of improved cardiovascular outcome,” he said. “Further studies are needed to clarify optimal management for this specific high-risk patient population.”

In addition to Inohara, Duke contributors to the research included Peter Shrader, Karen Pieper, Rosalia Blanco, Eric Peterson, and Jonathan Piccini.