Title:STOPP/START Anti-aggregation and Anticoagulation Alerts in Atrial
Fibrillation
Volume: 21
Issue: 3
Author(s): Francesco Salis*, Antonella Palimodde, Samuele Rundeddu and Antonella Mandas
Affiliation:
- Department of Medical Sciences, and Public Health, University of Cagliari, Cagliari, Italy
Keywords:
Atrial fibrillation, comorbidities, comprehensive geriatric assessment (CGA), potentially inappropriate medication (PIM), potentially prescribing omission, screening tool to alert to right treatment (START), screening tool of older persons’ prescriptions (STOPP), STOPP/START criteria, potential prescribing omission (PPO).
Abstract:
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, which also did not present a 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.
Conclusion: 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.
