Net clinical benefit of adding aspirin to warfarin in patients with atrial fibrillation

Insights from the J-RHYTHM Registry

J-RHYTHM Registry Investigators

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Concomitant use of vitamin K antagonist (VKA) and aspirin (ASA) is becoming increasingly prevalent among atrial fibrillation (AF) patients. We quantified the net clinical benefit of adding ASA to a VKA using nationwide prospective AF registry data. Methods We studied 6074 patients (VKA monotherapy: 83% and VKA + ASA: 17%) between January 2009 and July 2009, and followed them for a mean follow-up period of 2 years. The risk of strokes and bleeding was calculated by the CHA2DS2-VASc and HAS-BLED scores. The net clinical benefit was defined as the annual rate of ischemic strokes and systemic emboli prevented by VKAs minus intracranial hemorrhages attributable to the VKA + ASA, multiplied by an impact weight of 1.5. Results Patients on a VKA + ASA were older with more medical comorbidities than those on VKA alone. Using VKA monotherapy as a reference, higher major bleeding rates and all-cause death were evident in those on VKA + ASA. The net clinical benefit of VKA + ASA for the overall cohort was - 0.1%/year (95% confidence interval, - 0.74% to 0.46%). There was a trend toward a negative net clinical benefit from VKA + ASA in patients with a CHA2DS2-VASc ≥ 2 and HAS-BLED ≤ 2 (- 1.17%/year). The VKA + ASA yielded a positive net clinical benefit in patients with a CHA2DS2-VASc ≥ 2 and HAS-BLED ≥ 3 (1.16%/year). The result patterns were relatively constant using impact weight of 1.0 and 2.0. Conclusions Our estimates of the net clinical benefit can provide a useful anchoring point for adding ASA to VKA in patients with AF.

Original languageEnglish
Pages (from-to)311-317
Number of pages7
JournalInternational Journal of Cardiology
Volume212
DOIs
Publication statusPublished - 01-06-2016

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Vitamin K
Warfarin
Atrial Fibrillation
Aspirin
Registries
Stroke
Hemorrhage
Weights and Measures
Intracranial Hemorrhages
Embolism
Comorbidity
Cause of Death

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{feb6c0a4d9fe40a2972fddd7f7232e60,
title = "Net clinical benefit of adding aspirin to warfarin in patients with atrial fibrillation: Insights from the J-RHYTHM Registry",
abstract = "Background Concomitant use of vitamin K antagonist (VKA) and aspirin (ASA) is becoming increasingly prevalent among atrial fibrillation (AF) patients. We quantified the net clinical benefit of adding ASA to a VKA using nationwide prospective AF registry data. Methods We studied 6074 patients (VKA monotherapy: 83{\%} and VKA + ASA: 17{\%}) between January 2009 and July 2009, and followed them for a mean follow-up period of 2 years. The risk of strokes and bleeding was calculated by the CHA2DS2-VASc and HAS-BLED scores. The net clinical benefit was defined as the annual rate of ischemic strokes and systemic emboli prevented by VKAs minus intracranial hemorrhages attributable to the VKA + ASA, multiplied by an impact weight of 1.5. Results Patients on a VKA + ASA were older with more medical comorbidities than those on VKA alone. Using VKA monotherapy as a reference, higher major bleeding rates and all-cause death were evident in those on VKA + ASA. The net clinical benefit of VKA + ASA for the overall cohort was - 0.1{\%}/year (95{\%} confidence interval, - 0.74{\%} to 0.46{\%}). There was a trend toward a negative net clinical benefit from VKA + ASA in patients with a CHA2DS2-VASc ≥ 2 and HAS-BLED ≤ 2 (- 1.17{\%}/year). The VKA + ASA yielded a positive net clinical benefit in patients with a CHA2DS2-VASc ≥ 2 and HAS-BLED ≥ 3 (1.16{\%}/year). The result patterns were relatively constant using impact weight of 1.0 and 2.0. Conclusions Our estimates of the net clinical benefit can provide a useful anchoring point for adding ASA to VKA in patients with AF.",
author = "{J-RHYTHM Registry Investigators} and Eiichi Watanabe and Mayumi Yamamoto and Itsuo Kodama and Hiroshi Inoue and Hirotsugu Atarashi and Ken Okumura and Takeshi Yamashita and Lip, {Gregory Y.H.} and Eitaro Kodani and Yuji Okuyama and Akiko Chishaki and Ken Kiyono and Hideki Origasa",
year = "2016",
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language = "English",
volume = "212",
pages = "311--317",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

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Net clinical benefit of adding aspirin to warfarin in patients with atrial fibrillation : Insights from the J-RHYTHM Registry. / J-RHYTHM Registry Investigators.

In: International Journal of Cardiology, Vol. 212, 01.06.2016, p. 311-317.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Net clinical benefit of adding aspirin to warfarin in patients with atrial fibrillation

T2 - Insights from the J-RHYTHM Registry

AU - J-RHYTHM Registry Investigators

AU - Watanabe, Eiichi

AU - Yamamoto, Mayumi

AU - Kodama, Itsuo

AU - Inoue, Hiroshi

AU - Atarashi, Hirotsugu

AU - Okumura, Ken

AU - Yamashita, Takeshi

AU - Lip, Gregory Y.H.

AU - Kodani, Eitaro

AU - Okuyama, Yuji

AU - Chishaki, Akiko

AU - Kiyono, Ken

AU - Origasa, Hideki

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background Concomitant use of vitamin K antagonist (VKA) and aspirin (ASA) is becoming increasingly prevalent among atrial fibrillation (AF) patients. We quantified the net clinical benefit of adding ASA to a VKA using nationwide prospective AF registry data. Methods We studied 6074 patients (VKA monotherapy: 83% and VKA + ASA: 17%) between January 2009 and July 2009, and followed them for a mean follow-up period of 2 years. The risk of strokes and bleeding was calculated by the CHA2DS2-VASc and HAS-BLED scores. The net clinical benefit was defined as the annual rate of ischemic strokes and systemic emboli prevented by VKAs minus intracranial hemorrhages attributable to the VKA + ASA, multiplied by an impact weight of 1.5. Results Patients on a VKA + ASA were older with more medical comorbidities than those on VKA alone. Using VKA monotherapy as a reference, higher major bleeding rates and all-cause death were evident in those on VKA + ASA. The net clinical benefit of VKA + ASA for the overall cohort was - 0.1%/year (95% confidence interval, - 0.74% to 0.46%). There was a trend toward a negative net clinical benefit from VKA + ASA in patients with a CHA2DS2-VASc ≥ 2 and HAS-BLED ≤ 2 (- 1.17%/year). The VKA + ASA yielded a positive net clinical benefit in patients with a CHA2DS2-VASc ≥ 2 and HAS-BLED ≥ 3 (1.16%/year). The result patterns were relatively constant using impact weight of 1.0 and 2.0. Conclusions Our estimates of the net clinical benefit can provide a useful anchoring point for adding ASA to VKA in patients with AF.

AB - Background Concomitant use of vitamin K antagonist (VKA) and aspirin (ASA) is becoming increasingly prevalent among atrial fibrillation (AF) patients. We quantified the net clinical benefit of adding ASA to a VKA using nationwide prospective AF registry data. Methods We studied 6074 patients (VKA monotherapy: 83% and VKA + ASA: 17%) between January 2009 and July 2009, and followed them for a mean follow-up period of 2 years. The risk of strokes and bleeding was calculated by the CHA2DS2-VASc and HAS-BLED scores. The net clinical benefit was defined as the annual rate of ischemic strokes and systemic emboli prevented by VKAs minus intracranial hemorrhages attributable to the VKA + ASA, multiplied by an impact weight of 1.5. Results Patients on a VKA + ASA were older with more medical comorbidities than those on VKA alone. Using VKA monotherapy as a reference, higher major bleeding rates and all-cause death were evident in those on VKA + ASA. The net clinical benefit of VKA + ASA for the overall cohort was - 0.1%/year (95% confidence interval, - 0.74% to 0.46%). There was a trend toward a negative net clinical benefit from VKA + ASA in patients with a CHA2DS2-VASc ≥ 2 and HAS-BLED ≤ 2 (- 1.17%/year). The VKA + ASA yielded a positive net clinical benefit in patients with a CHA2DS2-VASc ≥ 2 and HAS-BLED ≥ 3 (1.16%/year). The result patterns were relatively constant using impact weight of 1.0 and 2.0. Conclusions Our estimates of the net clinical benefit can provide a useful anchoring point for adding ASA to VKA in patients with AF.

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U2 - 10.1016/j.ijcard.2016.03.008

DO - 10.1016/j.ijcard.2016.03.008

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JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

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