Background: Concomitant aspirin (ASA) is often prescribed in anticoagulated patients with atrial fibrillation (AF). We aimed to investigate the relationship between ASA use and quality of anticoagulation control determining major adverse outcomes.
Methods: An ancillary analysis of patients in the warfarin arm of the SPORTIF III and V trials was performed. Quality of anticoagulation control was defined using time in therapeutic range (TTR).
Results: 3624 AF patients on warfarin were available for analysis: 1712 (47.2%) were ASA non-users with good anticoagulation control (TTR≥65%) [Group I], 380 (10.5%) were ASA users with TTR≥65% [Group II], 1192 (32.9%) were ASA non-users with TTR<65% [Group III] and 340 (9.4%) were ASA users with TTR<65% [Group IV]. CHADS-VASc was similar across the groups (p=0.350), conversely HAS-BLED was progressively higher (p<0.001). At follow-up, stroke/systemic embolism rates were similar across the groups (p=0.162). Conversely, a progressively higher rate for major bleeding was found (p=0.034), as well as higher rates for all-cause death in Group III and IV (p<0.001). Kaplan-Meier analyses found a progressively higher risk for major bleeding across the groups (p=0.005) and a higher all-cause death risk in Group III and IV (p<0.001). Cox regression analysis confirmed that Group III and IV were at higher risk for major bleeding (p=0.005) and all-cause death (p=0.010).
Conclusions: Poor anticoagulation control is associated with higher bleeding risk, which is even greater with concomitant ASA use, with no difference in stroke/SE risk. Poor anticoagulation control is associated with a higher risk for all-cause death, independent of concomitant ASA use.
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