Frequent and possibly inappropriate use of combination therapy with an oral anticoagulant and antiplatelet agents in patients with atrial fibrillation in Europe

Research output: Contribution to journalArticlepeer-review


  • Raffaele De Caterina
  • Bettina Ammentorp
  • Harald Darius
  • Jean-Yves Le Heuzey
  • Giulia Renda
  • Richard John Schilling
  • Tessa Schliephacke
  • Paul-Egbert Reimitz
  • Josef Schmitt
  • Christine Schober
  • José Luis Zamorano
  • Paulus Kirchhof
  • PREFER in AF Registry Investigators

Colleges, School and Institutes


PURPOSE: 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.

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Original languageEnglish
Pages (from-to)1625-35
Number of pages11
Issue number20
Publication statusPublished - Oct 2014


  • Aged, Anticoagulants, Atrial Fibrillation, Cardiovascular Diseases, Drug Therapy, Combination, Europe, Female, Humans, Inappropriate Prescribing, Male, Platelet Aggregation Inhibitors, Prospective Studies, Thromboembolism

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