Long-Term Aspirin Unnecessary Following Atrial Fibrillation Ablation

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Bleeding risks increased in low-risk patients with aspirin therapy following AF ablation.
Bleeding risks increased in low-risk patients with aspirin therapy following AF ablation.

Patients with atrial fibrillation (AF) at a low risk for stroke experience no significant benefit from long-term aspirin therapy after catheter ablation and are at high risk of bleeding compared with patients who receive warfarin or no therapy, according to a study published in the Journal of Cardiovascular Electrophysiology.1

The investigators compared 1- and 3-year outcomes in patients with AF who underwent ablation, focusing on transient ischemic attack (TIA), cerebrovascular accident (CVA), gastrointestinal (GI) bleeding, genitourinary (GU) bleeding, any bleeding events, and AF recurrence. A total of 4124 patients with AF were categorized into 3 treatment groups: aspirin, warfarin, and no therapy. The CHA2DS2VASc score (0, 1, and 2) was used to identify risk factors.

At 1 year, 60.2% of patients were not on therapy compared with patients taking warfarin (2.5%) and aspirin (37.3%). At 3 years, 75.5% of patients were on no therapy, 5.9% were taking warfarin, and 18.6% were taking aspirin.

Adverse outcomes were stratified by CHA2DS2VASc score: at 3 years, the rate of CVA/TIA was 3.9% for a CHA2DS2VASc score of 0, 3.0% for a CHA2DS2VASc score of 1, and 1.4% for a CHA2DS2VASc score of 2 (P <.0001). Rates of GI and GU bleeding followed a similar trend: at 3 years, the rate of GI bleeding was 0.8% for a CHA2DS2VASc score of 0, 1.9% for a CHA2DS2VASc score of 1, and 1.1% for a CHA2DS2VASc score of 2 (P =.53), while the rate of GU bleeding was 1.7% for a CHA2DS2VASc score of 0, 2.8% for a CHA2DS2VASc score  of 1, and 2.1% for a CHA2DS2VASc score of 2 (P =.55). The researchers noted a greater risk for CVA/TIA in patients who received aspirin compared with warfarin or no therapy across all CHA2DS2VASc scores.

Because of the study's observational nature, the researchers noted that their findings merely demonstrate associations rather than causality. A true comparison of the patient groups with a randomized study design may provide findings that hold greater clinical validity. The researchers also commented that aspirin therapy may have been underreported, which might have played a role in the observed bleeding rates in the group that received no therapy.

The investigators concluded that their findings “continue to highlight that aspirin conveys no significant benefit for stroke reduction in low stroke risk AF patients without vascular disease and escalates risk of bleeding.”

Disclosures: Dr Bunch reports receiving a research grant from Boehringer Ingelheim.

Reference

Jacobs V, May HT, Bair TL, et al. Long-term aspirin does not lower risk of stroke and increases bleeding risk in low risk atrial fibrillation ablation patients [published online August 28, 2017]. J Cardiovasc Electrophysiol. doi:10.1111/jce.13327

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