Most Read Articles
Jairia Dela Cruz, 3 days ago
Metabolic and bariatric surgery (MBS) leads to large and sustained reductions in, and even reversal of, multiple risk factors for future joint disease in adolescents with severe obesity and musculoskeletal pain, according to data from the Teen Longitudinal Assessment of Bariatric Surgery study.
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
23 Dec 2019
At a Menarini-sponsored symposium held during the Asian Pacific Society Congress, renowned cardiologist Prof John Camm provided the latest evidence for chronic stable angina with or without concomitant diseases, with a special focus on the antianginal agent ranolazine and combination therapies. The event was chaired and moderated by Dr Dante Morales from the University of the Philippines College of Medicine.
Pearl Toh, 6 days ago
Obeticholic acid significantly improves fibrosis and disease activity in patients with nonalcoholic steatohepatitis (NASH), a chronic liver disease currently with no approved therapy, according to an interim analysis of the landmark REGENERATE* study.

Aspirin increases bleeding in DOAC-treated patients

Audrey Abella
23 Dec 2019
Dr Jordan Schaefer

The addition of aspirin to direct oral anticoagulant (DOAC) therapy without apparent indication resulted in more bleeding events, according to data presented at ASH 2019.

“There has been a growing body of evidence raising the question of whether adding aspirin does more harm than good for certain patients,” said study author Dr Jordan Schaefer from the University of Michigan in Ann Arbor, Michigan, US. This question centred on the risk of increased bleeding with aspirin use without protection from adverse thrombotic events, he specified, particularly among individuals on full-dose anticoagulation.

“Therefore, [we sought to determine] the impact of adding aspirin to DOAC therapy without a clear indication for aspirin … [Our findings showed that this] combination led to more bleeding, especially clinically relevant nonmajor bleeding (CRNMB),” said Dr Schaefer.

The rate of CRNMB was significantly higher among participants receiving DOAC and aspirin vs those on DOAC only (18.70 vs 13.50 events/100 patient years [PY]; p=0.02); a similar effect was observed with NMB (32.82 vs 25.88 events/100 PY; p=0.04). However, the overall bleeding rate, albeit numerically higher, did not achieve statistical significance (39.50 vs 32.32 events/100 PY; p=0.07). [ASH 2019, abstract 787]

Moreover, the DOAC-aspirin combination led to higher hospitalization rates (11.76 vs 9.04 events/100 PY) and emergency room visits (17.96 vs 14.61 events/100 PY) than DOAC only. The most common sites of bleeding were cutaneous (eg, bruising), gastrointestinal, and genitourinary areas.

Schaefer and his team arrived at these findings using the Michigan Anticoagulation Quality Improvement initiative, which prospectively enrolled 2,045 individuals newly initiating on DOAC. Of these, nearly a third were on aspirin, 90 percent of whom were receiving a dose of ≤100 mg. A total of 639 aspirin recipients were propensity matched against 639 individuals on DOAC only (mean age 71.7 years, 55.9 percent male) and were followed up for approximately 15 months.

A majority of participants (87.7 percent) were on high-dose DOAC mostly for atrial fibrillation (74.4 percent). The most common DOACs used were apixaban and rivaroxaban (67.3 percent and 31.4 percent, respectively). The rates of new thrombosis were similar between the two groups (2.35 vs 2.23 events/100 PY for DOAC-aspirin vs DOAC, respectively).

Despite the large study registry that encompassed comprehensive thrombotic and bleeding outcomes, the strong propensity matching, and diverse patient groups included in the study, Schaefer called for larger confirmatory studies that should also explore outcomes in key patient subgroups. “Until such data are available, clinicians and patients should balance the risk/benefit of aspirin plus DOAC.”

­

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Jairia Dela Cruz, 3 days ago
Metabolic and bariatric surgery (MBS) leads to large and sustained reductions in, and even reversal of, multiple risk factors for future joint disease in adolescents with severe obesity and musculoskeletal pain, according to data from the Teen Longitudinal Assessment of Bariatric Surgery study.
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
23 Dec 2019
At a Menarini-sponsored symposium held during the Asian Pacific Society Congress, renowned cardiologist Prof John Camm provided the latest evidence for chronic stable angina with or without concomitant diseases, with a special focus on the antianginal agent ranolazine and combination therapies. The event was chaired and moderated by Dr Dante Morales from the University of the Philippines College of Medicine.
Pearl Toh, 6 days ago
Obeticholic acid significantly improves fibrosis and disease activity in patients with nonalcoholic steatohepatitis (NASH), a chronic liver disease currently with no approved therapy, according to an interim analysis of the landmark REGENERATE* study.