Aspirin frequently used by patients on direct oral anticoagu
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It is unclear how many patients treated with a direct oral anticoagulant (DOAC) are using concomitant acetylsalicylic acid (ASA, or aspirin) and how this affects clinical outcomes.

This study aimed to evaluate the frequency and outcomes of prescription of concomitant ASA and DOAC therapy for patients with atrial fibrillation (AF) or venous thromboembolic disease (VTE).

This registry-based cohort study took place at 4 anticoagulation clinics in Michigan. Eligible participants were adults undergoing treatment with a DOAC for AF or VTE, without a recent myocardial infarction (MI) or history of heart valve replacement, with at least 3 months of follow-up.

-- Of the study cohort of 3280 patients (1673 men; mean age 68.2 years), 1107 (33.8%) patients without a clear indication for ASA were being treated with DOACs and ASA.

-- Two propensity score–matched cohorts, each with 1047 patients, were analyzed (DOAC plus ASA and DOAC only).

-- Patients were followed up for a mean (SD) of 20.9 (19.0) months. Patients taking DOAC and ASA experienced more bleeding events compared with DOAC monotherapy (26.0 bleeds vs 31.6 bleeds per 100 patient years).

-- Specifically, patients undergoing combination therapy had significantly higher rates of nonmajor bleeding (26.1 bleeds vs 21.7 bleeds per 100 patient years) compared with DOAC monotherapy.

-- Major bleeding rates were similar between the 2 cohorts. Thrombotic event rates were also similar between the cohorts (2.5 events vs 2.3 events per 100 patient years for patients treated with DOAC and ASA compared with DOAC monotherapy).

-- Patients were more often hospitalized while undergoing combination therapy (9.1 vs 6.5 admissions per 100 patient years).

Conclusively, nearly one-third of patients with AF and/or VTE who were treated with a DOAC received ASA without a clear indication. Compared with DOAC monotherapy, concurrent DOAC and ASA use was associated with increased bleeding and hospitalizations but similar observed thrombosis rate. Future research should identify and deprescribe ASA for patients when the risk exceeds the anticipated benefit.