Abstract | BACKGROUND: METHODS: RESULTS: A total of 5,205 (36.5%) patients were receiving aspirin at baseline (mean dose 99.2mg); 30.6% of those had known CAD. Patients receiving aspirin were more likely to have prior myocardial infarction (22% vs 14%; P<.001) and heart failure (68% vs 59%; P<.001). Relative efficacy of rivaroxaban versus warfarin was similar with and without aspirin use for both stroke/systemic embolism (P=.95 for interaction), and major or NMCR bleeding (P=.76 for interaction). After adjustment, aspirin use was associated with similar rates of stroke/systemic embolism (hazard ratio [HR] 1.16, 95% CI 0.98-1.37; P=.094) but higher rates of all-cause death (HR 1.27, 95% CI 1.13-1.42; P<.0001) and major or NMCR bleeding (HR 1.32, 95% CI 1.21-1.43; P<.0001). There was a significant interaction between no CAD at baseline and aspirin for all-cause death (P=.009). CONCLUSIONS:
Aspirin use at baseline was associated with an increased risk for bleeding and all-cause death in ROCKET AF, a risk most pronounced in patients without known CAD. Although these findings may reflect unmeasured clinical factors, further investigation is warranted to determine optimal aspirin use in patients with AF.
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Authors | Rohan Shah, Anne Hellkamp, Yuliya Lokhnygina, Richard C Becker, Scott D Berkowitz, Günter Breithardt, Werner Hacke, Jonathan L Halperin, Graeme J Hankey, Keith A A Fox, Christopher C Nessel, Kenneth W Mahaffey, Jonathan P Piccini, Daniel E Singer, Manesh R Patel, ROCKET AF Steering Committee Investigators |
Journal | American heart journal
(Am Heart J)
Vol. 179
Pg. 77-86
(09 2016)
ISSN: 1097-6744 [Electronic] United States |
PMID | 27595682
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2016 Elsevier Inc. All rights reserved. |
Chemical References |
- Anticoagulants
- Factor Xa Inhibitors
- Platelet Aggregation Inhibitors
- Warfarin
- Rivaroxaban
- Aspirin
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Topics |
- Aged
- Anticoagulants
(therapeutic use)
- Aspirin
(therapeutic use)
- Atrial Fibrillation
(complications, drug therapy, epidemiology)
- Comorbidity
- Drug Therapy, Combination
- Embolism
(etiology, prevention & control)
- Factor Xa Inhibitors
(therapeutic use)
- Female
- Heart Failure
(epidemiology)
- Hemorrhage
(chemically induced)
- Humans
- Male
- Middle Aged
- Mortality
- Myocardial Infarction
(epidemiology)
- Platelet Aggregation Inhibitors
(therapeutic use)
- Randomized Controlled Trials as Topic
- Risk Factors
- Rivaroxaban
(therapeutic use)
- Stroke
(etiology, prevention & control)
- Warfarin
(therapeutic use)
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