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Underuse of Oral Anticoagulants and Inappropriate Prescription of Antiplatelet Therapy in Older Inpatients with Atrial Fibrillation

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Abstract

Background

Several studies have shown that the prescription of antiplatelet therapy (APT) is associated with an increased risk of oral anticoagulant (OAC) underuse in patients aged 75 years and over with atrial fibrillation (AF). An associated atheromatous disease may be the underlying reason for APT prescription. The objective of the study was to determine whether the association between underuse of OAC and APT prescription was explained by the presence of an atheromatous disease.

Methods and Results

We performed a retrospective, observational, single-centre study between 2009 and 2013 based on administrative data. Patients aged 75 years and over with non-valvular AF were identified in a database of 72,090 hospital stays. Prescriptions of anti-thrombotic medications and their association with the presence of atheromatous disease were evaluated by the mean of a logistic regression. A total of 2034 hospital stays were included (mean age 84.3 ± 5.2 years). The overall prevalence of known atheromatous disease was 25.9%. OAC underuse was observed in 58.5% of the stays. In multivariable analysis, the prescription of an APT was associated with an increased risk of OAC underuse [odds ratio (OR) 6.85; 95% confidence interval (CI) 5.50–8.58], independently of the presence of a concomitant known atheromatous disease (OR 0.78; 95% CI 0.60–1.01). Among the 692 stays with APT monotherapy (34.0%), 232 (33.5%) displayed an atheromatous disease.

Conclusions

The underuse of OAC is associated with the prescription of APT in older patients with AF, regardless of the presence or absence of known atheromatous disease. Our results suggest that APT is often inappropriately prescribed instead of OAC.

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Acknowledgements

We sincerely thank all the physicians who participated in the PSIP project in their respective departments, notably Dr. Pascale Leurs, Dr. Olivier Brimont, Dr. Zine Baarir, and Dr. Philippe Lecocq. We thank Renaud Perichon and Sophie Quenton (health informatics engineers) for their precious assistance.

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Authors and Affiliations

  1. Geriatrics Department, CHRU Lille, 2 Avenue Oscar Lambret, 59000, Lille, France

    Lorette Averlant, François Puisieux & Jean-Baptiste Beuscart

  2. EA 2694, Santé publique: épidémiologie et qualité des soins, Univ. Lille, 59000, Lille, France

    Grégoire Ficheur, Laurie Ferret, Julien Soula, Alexandre Georges, Régis Beuscart, Emmanuel Chazard & Jean-Baptiste Beuscart

  3. Cardiology Department, CHRU Lille, 59000, Lille, France

    Stéphane Boulé

  4. Pharmacy Department, Denain General Hospital, 59220, Denain, France

    Michel Luyckx

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  1. Lorette Averlant
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Correspondence to Lorette Averlant.

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Conflict of interest

Lorette Averlant, Grégoire Ficheur, Laurie Ferret, Stéphane Boulé, François Puisieux, Michel Luyckx, Julien Soula, Alexandre Georges, Régis Beuscart, Emmanuel Chazard, and Jean-Baptiste Beuscart declare that they have no conflict of interest that might be relevant to the contents of this article.

Funding

This study was funded by the Fondation pour la Recherche Médicale (FRM). Responsibility for the design, analysis, interpretation of data and conclusions lies with the authors.

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Averlant, L., Ficheur, G., Ferret, L. et al. Underuse of Oral Anticoagulants and Inappropriate Prescription of Antiplatelet Therapy in Older Inpatients with Atrial Fibrillation. Drugs Aging 34, 701–710 (2017). https://doi.org/10.1007/s40266-017-0477-3

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