Patients with Atrial Fibrillation are Unlikely to Benefit from Aspirin Monotherapy

Abstract

Nan Wang,1 Qiqi Hou,2 Shouling Wu,3 Quanle Han,4 Kangbo Li5 1Catheterization Unit, Tangshan Gongren Hospital, Tangshan, People’s Republic of China; 2Hebei Medical University, Shijiazhuang, People’s Republic of China; 3Department of Cardiology, Kailuan General Hospital, Tangshan, People’s Republic of China; 4Department of Cardiology, Tangshan Gongren Hospital, Tangshan, People’s Republic of China; 5School of Clinical Medicine, North China University of Science and Technology, Tangshan, People’s Republic of ChinaCorrespondence: Quanle Han, Email [email protected]: Aspirin (ASA), the mainstay antiplatelet treatment in patients with cardiovascular disease (CVD), has been received by a considerable number of AF patients. This study sought to examine the association between ASA monotherapy and the risk of major adverse cardiac and cerebrovascular events (MACCE) in patients with atrial fibrillation (AF).Methods: A total of 850 patients with AF were identified from a community-based Kailuan study. All patients were assigned to two groups according to their medicine history: an aspirin therapy group (ASA group) (n = 174), and a non-aspirin therapy group (non-ASA group) (n = 676). The clinical endpoints are MACCE, including myocardial infarction (MI), ischemic stroke (IS), and hemorrhagic stroke (HS). Incidence curves for MACCE were plotted using the Kaplan–Meier method, and the Log rank test was used to assess the differences in incidence rates. The hazard ratios (HR) and 95% confidence intervals (CI) for MACCE were analyzed using Cox proportional-hazards analysis regression models.Results: During the 7.2-year follow-up, 30 MACCE occurred in the ASA group, and 101 in the non-ASA group, with a cumulative incidence of 19.88% vs 17.27%, P = 0.511; 3 cases of MI occurred in the ASA group, and 18 cases in the non-ASA group, with a cumulative incidence of 1.78% vs 2.90%, P = 0.305. Twenty-seven cases of IS occurred in the ASA group, and 84 cases in the non-ASA group, with a cumulative incidence of 1.78% vs 2.90%, P = 0.305. Eight cases of HS occurred in the ASA group, and 13 cases in the non-ASA group, with a cumulative incidence of 5.01% vs 2.34%, P = 0.045. Multivariate regression analysis showed that ASA therapy was not associated with MACCE (HR: 1.130, 95% CI: 0.747– 1.710, P = 0.562). In addition, ASA therapy was not associated with IS (HR: 1.309, 95% CI: 0.843– 2.034, P = 0.231). However, ASA therapy was significantly associated with HS (HR: 2.563, 95% CI: 1.024– 6.418, P = 0.044).Conclusion: ASA monotherapy is not associated with a lower risk of ischemic events, while significantly associated with a higher risk of bleeding events. Patients with AF are unlikely to benefit from aspirin monotherapy.Keywords: atrial fibrillation, aspirin monotherapy, major adverse cardiac and cerebrovascular events, myocardial infarction, ischemic stroke, hemorrhagic stroke

Keywords

• atrial fibrillation
• aspirin
• myocardial infarction
• stroke
• cha2ds2-vasc score