Priority Areas - Anticoagulants in atrial fibrillation: Antiplatelet monotherapy

For people with increased risk of stroke, the use of anticoagulants decreases the risk of all cause mortality and ischaemic stroke, compared to the use of single antiplatelet therapy, therefore antiplatelets are no longer recommended in patients with AF.

Despite this recommendation, data from the Sentinel Stroke Audit highlights that 15% of patients with known AF prior to being admitted with a stroke were prescribed an antiplatelet. This figure ranges from 14.8% to 18.8% across the health boards.

Its should be remembered that combinations of oral anticoagulants and antiplatelets increase bleeding risk and should be avoided in patients with AF unless there is a clear indication for use.

 Antiplatelet monotherapy

  • Antiplatelet medication, i.e. aspirin or clopidogrel, is no longer recommended in patients with atrial fibrillation.
  • Despite this, data from the Sentinel Stroke audit highlights that 15% of stroke patients across Wales, England and Northern Ireland with atrial fibrillation are still prescribed antiplatelet drugs.
  • Quality Statement 2 within the NICE Quality Standard for Atrial fibrillation states that adults with atrial fibrillation should not be prescribed aspirin as monotherapy, as the risks of taking aspirin outweigh any benefits.
  • This NPI aims to identify patients prescribed antiplatelet monotherapy in order for treatment to be reviewed.

Percentage of patients with AF who are prescribed antiplatelet monotherapy – September 2019

Graph 21 Antiplatelet monotherapy

 

How can changes be made?

  • Review patients with AF identified as being prescribed antiplatelet monotherapy.
  • Ensure patients are aware that antiplatelet monotherapy is no longer recommended in patients with AF as the risks outweigh the benefits.
  • Be aware that patients may need to take antiplatelets for other indications.

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