Oral anticoagulation with DAPT failed to reduce stroke rates in AF

[EngMac]

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(Explanation for DAPT: The DAPT Study is an independent, large-scale study in size and scope intended to determine the appropriate duration for dual antiplatelet therapy (the combination of aspirin and a second anti-clotting medication to reduce the risk of blood clots)

(Explanation for PCI: Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty or simply angioplasty, is a non-surgical procedure used to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease.)

"In a real-world patient population undergoing PCI, less than half of patients with a CHADS2 score ≥2 received oral anticoagulation with warfarin at hospital discharge. Despite this, rates of 5-year stroke were similar among those who did vs. did not receive oral anticoagulation."

"There is insufficient evidence surrounding the use of oral anticoagulants and dual antiplatelet therapy in atrial fibrillation among patients undergoing PCI, according to the researchers."

"The cumulative 5-year stroke rate was 13.8% among patients receiving oral anticoagulants and 11.8% among those not receiving the therapy, which the researchers noted was not significantly different (P=.49)."

"The investigators conducted a 4-month landmark analysis in the oral anticoagulation group. The stroke rate among 286 patients receiving DAPT in this analysis was 15.1% compared with 6.7% among 173 patients not receiving DAPT (P=.052). Major bleeding rates in this analysis were 14.7% for the DAPT group and 8.7% for the non-DAPT group (P=.10)."

"[Oral anticoagulation] was underused and its intensity was mostly suboptimal in ‘real world’ AF patients undergoing PCI, which led to inadequate stroke prevention,” the researchers concluded. “Long-term DAPT in patients receiving [oral anticoagulation] did not reduce stroke incidence.”

Website:

healio.com/cardiology/inter...

[Hidden]

Is it possible for someone to translate this into plain English? It appears to say that anti-coagulation did nothing to reduce stroke rates, and yet the final statement says that anti-coagulation was underused and therefore did not reduce stroke rates !!!

Also, there appears to be no attempt to state why some people were anti-coagluated and some weren't, so maybe the ones that were treated were the bad cases, and therefore most likely to have a stroke anyhow???

Koll

[AnticoagulateNow]

The reference here is for patients with heart disease, specifically narrowed arteries but nevertheless, like Koll, I find the figures hard to believe. The contradicting final sentence adds further confusion. Furthermore statistics which return only a 2% reduction in stroke rate 'twixt those on anticoagulants and those left untreated are a very long way from typical.

[CDreamer]

Thank you Koll for asking this question, I also found this report very confusing. Thanks also to Anticoagulatenow for your reply.

[Hidden]

Thank you anticoagulate now, my confusion was pretty well complete too

Lis

[SRMGrandma Volunteer]

Try to remember that this is just ONE study, and in this study 1057 pts with AF were looked at out of a group of over 12,000 patients all of whom had coronary artery disease to the extent that they required angioplasty. These were not otherwise healthy individuals who happen to have AF. It also clearly states "real world use" (code for not perfect dosing of the prescribed medication ) of anticoagulants so we have no way of knowing if these were compliant persons who really did take their anticoagulant as directed. So my take away from this is that if you have severe coronary artery disease along with your AF, they are seeing that you have increased risk of stroke despite taking the anticoagulant, which is not news and only makes sense. In any study there are often more questions raised than answers, and it takes many many studies to get a definitive answer that changes clinical practice. So to me, the best way to look at this information is that all of us who are exercising and lowering our cholesterol just got an even bigger reason to keep working to be healthy around our AF. We can't count on just the anticoagulants to be the only thing between us and a stoke, we must continue the work at chipping away at our risk factors and being as healthy as we can be.

[Terjo]

I agree with that , Grandma, I wish there was more research into why some people get this condition and others do not. What disposes people to this ? Is it just hereditary or other factors involved what can be done to prevent it ever happening in the first place. Has it been found to be random or are there markers that could be found earlier ?

Is there a universal study happening ? Terjo

[SRMGrandma Volunteer in reply to Terjo]

Hi Terjo, Unfortunately no universal study specifically on this topic. Studies take a lot of funding. There are good studies and poorly designed studies. Studies like the Harvard Nurses study follows the same people over decades and they really get great information from studies like that. Generally the smaller the number of people in a study the less likely that the conclusion is the final answer.

As far as the heredity question, people give way too much credit to their DNA. Your health is determined 70% by your own choices. The other 30% is a combination of 10% heredity; 10% environment; and 10% access to health care. You may be predisposed to heart disease and hypertension, or to cancer or diabetes, but if you modify factors that can bring that out you can avoid those things. I wish I knew 40 years ago what I know now about what I should have been eating and how I should have been exercising, or how I should have not let stress play such a huge role in my life. Food is powerful medicine, or conversely can be a huge detriment letting heart disease or diabetes take over. But here's the good news...when you know better, you do better. I've learned a lot and I've changed a lot to be as healthy as possible. By continuing these changes I expect my health will continue to be more excellent. Look at your family history as the random marker, tell your kids that their DNA is not their destiny, but a healthy lifestyle can change all of that.

[Terjo]

Thank you. Grandma, The Second World War started when I was 7 and so there wasn't the chance to over indulge in food although I was an only child.

Bread was still rationed in 1954 when I had my first child the NHS provided vitamins for all pregnant women and orange juice or rose hip syrup to every child. As my husband was still studying then we were very careful with how we ate.

As we had a large family later we had to be aware of how to make sure everyone had a fair share. I'm now sounding like a paragon of virtue but it wasn't like that. We smoked and drank until 40 years ago ( we stopped smoking then but still have the odd glass of wine).

Our youngest son is now 46 and the oldest 60, makes us feel very ancient but we're fortunate to be fit apart from my mongrel condition. My husband still paints large canvases and I rarely have time to sit around all day. Luckily I'm seeing the doctor tomorrow and shall ask about what to do about the last heart heart episode I had 10 days ago which was a racing heart beat of way over 100 not AF as still in regular rhythm ,couldn't take it on machine as felt too scared! I took 2.5mgs of bisoprolol but didn't do anything for hours and the the pulse was 31. It was ok the next morning. I just wish we could find a reason as it happens to young children too. Hope you keep well and positive. Terjo