STOPP/START antiaggregation and anticoagulation alerts in atrial fibrillation

BACKGROUND Atrial Fibrillation (AF) is common in the elderly. A key component of AF management is Oral Anticoagulant Therapy (OAT), consisting of Vitamin K Antagonists (VKAs) or Direct Oral Anticoagulants (DOACs). The aim of the present study is to check, using STOPP (Screening Tool of Older Persons’ Prescriptions)/START (Screening Tool to Alert to Right Treatment) Criteria, if such drugs are potentially inappropriately prescribed/omitted in an elderly population with AF, and to determine their impact on mortality. METHODS This study included patients (n=427) with nonvalvular AF consecutively evaluated between 2013 and 2019 at the Geriatric Outpatient Service, University Hospital of Monserrato, Cagliari, Italy, and followed-up for 36 months. The OAT-group included 330 patients; the other 97 patients constituted the non-OAT-group. The sample was assessed for STOPP/START criteria. RESULTS We found no difference (p>0.1) in comorbidity burden, frailty, and cardio-cerebro-vascular disease prevalence in the two groups, who also did not present difference in 36-month mortality (p=0.97). OAT was overall appropriately taken, and 62.4% of OAT-group presented the START criterion to take antiplatelets but also the STOPP criterion not to take them, because of the simultaneous anticoagulant intake. In the non-OAT-group, 69.1% presented the START criterion to take anticoagulants, and 21.6% the START criterion to take antiplatelets. CONCLUSIONS Patients with AF are often prone to under- or over-prescription, particularly of antithrombotic drugs. The STOPP/START criteria are a valid tool to assess and correct wrong therapeutic choices. In frail and comorbid subjects, survival is not correlated with the assumption of OAT.