Oral anticoagulation and antiplatelets in atrial fibrillation patients after myocardial infarction and coronary intervention
The purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI). The optimal antithrombotic treatment strategy is...
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| Published in: | Journal of the American College of Cardiology Vol. 62; no. 11; p. 981 |
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| Main Authors: | , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
10.09.2013
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| Subjects: | |
| ISSN: | 1558-3597, 1558-3597 |
| Online Access: | Get more information |
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| Abstract | The purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI).
The optimal antithrombotic treatment strategy is unresolved in patients with multiple indications.
A total of 12,165 AF patients hospitalized with MI and/or undergoing PCI between 2001 and 2009 were identified by nationwide registries (60.7% male; mean age 75.6 years). Risk of MI/coronary death, ischemic stroke, and bleeding according to antithrombotic treatment regimen was estimated by Cox regression models.
Within 1 year, MI or coronary death, ischemic stroke, and bleeding events occurred in 2,255 patients (18.5%), 680 (5.6%), and 769 (6.3%), respectively. Relative to triple therapy (oral anticoagulation [OAC] plus aspirin plus clopidogrel), no increased risk of recurrent coronary events was seen for OAC plus clopidogrel (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.48 to 1.00), OAC plus aspirin (HR: 0.96, 95% CI: 0.77 to 1.19), or aspirin plus clopidogrel (HR: 1.17, 95% CI: 0.96 to 1.42), but aspirin plus clopidogrel was associated with a higher risk of ischemic stroke (HR: 1.50, 95% CI: 1.03 to 2.20). Also, OAC plus aspirin and aspirin plus clopidogrel were associated with a significant increased risk of all-cause death (HR: 1.52, 95% CI: 1.17 to 1.99 and HR: 1.60, 95% CI: 1.25 to 2.05, respectively). When compared to triple therapy, bleeding risk was nonsignificantly lower for OAC plus clopidogrel (HR: 0.78, 95% CI: 0.55 to 1.12) and significantly lower for OAC plus aspirin and aspirin plus clopidogrel.
In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy. |
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| AbstractList | The purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI).
The optimal antithrombotic treatment strategy is unresolved in patients with multiple indications.
A total of 12,165 AF patients hospitalized with MI and/or undergoing PCI between 2001 and 2009 were identified by nationwide registries (60.7% male; mean age 75.6 years). Risk of MI/coronary death, ischemic stroke, and bleeding according to antithrombotic treatment regimen was estimated by Cox regression models.
Within 1 year, MI or coronary death, ischemic stroke, and bleeding events occurred in 2,255 patients (18.5%), 680 (5.6%), and 769 (6.3%), respectively. Relative to triple therapy (oral anticoagulation [OAC] plus aspirin plus clopidogrel), no increased risk of recurrent coronary events was seen for OAC plus clopidogrel (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.48 to 1.00), OAC plus aspirin (HR: 0.96, 95% CI: 0.77 to 1.19), or aspirin plus clopidogrel (HR: 1.17, 95% CI: 0.96 to 1.42), but aspirin plus clopidogrel was associated with a higher risk of ischemic stroke (HR: 1.50, 95% CI: 1.03 to 2.20). Also, OAC plus aspirin and aspirin plus clopidogrel were associated with a significant increased risk of all-cause death (HR: 1.52, 95% CI: 1.17 to 1.99 and HR: 1.60, 95% CI: 1.25 to 2.05, respectively). When compared to triple therapy, bleeding risk was nonsignificantly lower for OAC plus clopidogrel (HR: 0.78, 95% CI: 0.55 to 1.12) and significantly lower for OAC plus aspirin and aspirin plus clopidogrel.
In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy. The purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI).OBJECTIVESThe purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI).The optimal antithrombotic treatment strategy is unresolved in patients with multiple indications.BACKGROUNDThe optimal antithrombotic treatment strategy is unresolved in patients with multiple indications.A total of 12,165 AF patients hospitalized with MI and/or undergoing PCI between 2001 and 2009 were identified by nationwide registries (60.7% male; mean age 75.6 years). Risk of MI/coronary death, ischemic stroke, and bleeding according to antithrombotic treatment regimen was estimated by Cox regression models.METHODSA total of 12,165 AF patients hospitalized with MI and/or undergoing PCI between 2001 and 2009 were identified by nationwide registries (60.7% male; mean age 75.6 years). Risk of MI/coronary death, ischemic stroke, and bleeding according to antithrombotic treatment regimen was estimated by Cox regression models.Within 1 year, MI or coronary death, ischemic stroke, and bleeding events occurred in 2,255 patients (18.5%), 680 (5.6%), and 769 (6.3%), respectively. Relative to triple therapy (oral anticoagulation [OAC] plus aspirin plus clopidogrel), no increased risk of recurrent coronary events was seen for OAC plus clopidogrel (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.48 to 1.00), OAC plus aspirin (HR: 0.96, 95% CI: 0.77 to 1.19), or aspirin plus clopidogrel (HR: 1.17, 95% CI: 0.96 to 1.42), but aspirin plus clopidogrel was associated with a higher risk of ischemic stroke (HR: 1.50, 95% CI: 1.03 to 2.20). Also, OAC plus aspirin and aspirin plus clopidogrel were associated with a significant increased risk of all-cause death (HR: 1.52, 95% CI: 1.17 to 1.99 and HR: 1.60, 95% CI: 1.25 to 2.05, respectively). When compared to triple therapy, bleeding risk was nonsignificantly lower for OAC plus clopidogrel (HR: 0.78, 95% CI: 0.55 to 1.12) and significantly lower for OAC plus aspirin and aspirin plus clopidogrel.RESULTSWithin 1 year, MI or coronary death, ischemic stroke, and bleeding events occurred in 2,255 patients (18.5%), 680 (5.6%), and 769 (6.3%), respectively. Relative to triple therapy (oral anticoagulation [OAC] plus aspirin plus clopidogrel), no increased risk of recurrent coronary events was seen for OAC plus clopidogrel (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.48 to 1.00), OAC plus aspirin (HR: 0.96, 95% CI: 0.77 to 1.19), or aspirin plus clopidogrel (HR: 1.17, 95% CI: 0.96 to 1.42), but aspirin plus clopidogrel was associated with a higher risk of ischemic stroke (HR: 1.50, 95% CI: 1.03 to 2.20). Also, OAC plus aspirin and aspirin plus clopidogrel were associated with a significant increased risk of all-cause death (HR: 1.52, 95% CI: 1.17 to 1.99 and HR: 1.60, 95% CI: 1.25 to 2.05, respectively). When compared to triple therapy, bleeding risk was nonsignificantly lower for OAC plus clopidogrel (HR: 0.78, 95% CI: 0.55 to 1.12) and significantly lower for OAC plus aspirin and aspirin plus clopidogrel.In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy.CONCLUSIONSIn real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy. |
| Author | Hansen, Morten Lock Gislason, Gunnar H Olesen, Jonas Bjerring Mikkelsen, Anders Christensen, Christine Benn Lamberts, Morten Schjerning Olsen, Anne-Marie Kristensen, Søren Lund Lip, Gregory Y H Køber, Lars Torp-Pedersen, Christian |
| Author_xml | – sequence: 1 givenname: Morten surname: Lamberts fullname: Lamberts, Morten email: mortenlamberts@gmail.com organization: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark. mortenlamberts@gmail.com – sequence: 2 givenname: Gunnar H surname: Gislason fullname: Gislason, Gunnar H – sequence: 3 givenname: Jonas Bjerring surname: Olesen fullname: Olesen, Jonas Bjerring – sequence: 4 givenname: Søren Lund surname: Kristensen fullname: Kristensen, Søren Lund – sequence: 5 givenname: Anne-Marie surname: Schjerning Olsen fullname: Schjerning Olsen, Anne-Marie – sequence: 6 givenname: Anders surname: Mikkelsen fullname: Mikkelsen, Anders – sequence: 7 givenname: Christine Benn surname: Christensen fullname: Christensen, Christine Benn – sequence: 8 givenname: Gregory Y H surname: Lip fullname: Lip, Gregory Y H – sequence: 9 givenname: Lars surname: Køber fullname: Køber, Lars – sequence: 10 givenname: Christian surname: Torp-Pedersen fullname: Torp-Pedersen, Christian – sequence: 11 givenname: Morten Lock surname: Hansen fullname: Hansen, Morten Lock |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23747760$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
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| Keywords | International Classification of Diseases bleeding AF CI oral anticoagulant myocardial infarction HR ICD stroke Anatomical Therapeutical Chemical ATC OAC atrial fibrillation percutaneous coronary intervention PCI hazard ratio confidence interval MI antithrombotic treatment |
| Language | English |
| License | Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
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| PublicationTitle | Journal of the American College of Cardiology |
| PublicationTitleAlternate | J Am Coll Cardiol |
| PublicationYear | 2013 |
| References | 23747772 - J Am Coll Cardiol. 2013 Sep 10;62(11):990-1 24509279 - J Am Coll Cardiol. 2014 Jul 15;64(2):231 24509278 - J Am Coll Cardiol. 2014 Jul 15;64(2):231-2 |
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| SubjectTerms | Administration, Oral Aged Aged, 80 and over Anticoagulants - adverse effects Anticoagulants - therapeutic use Aspirin - adverse effects Aspirin - therapeutic use Atrial Fibrillation - complications Atrial Fibrillation - therapy Denmark - epidemiology Drug Therapy, Combination Female Humans Incidence Male Myocardial Infarction - epidemiology Myocardial Infarction - etiology Myocardial Infarction - prevention & control Percutaneous Coronary Intervention Platelet Aggregation Inhibitors - adverse effects Platelet Aggregation Inhibitors - therapeutic use Postoperative Complications Registries Risk Factors Ticlopidine - adverse effects Ticlopidine - analogs & derivatives Ticlopidine - therapeutic use Treatment Outcome |
| Title | Oral anticoagulation and antiplatelets in atrial fibrillation patients after myocardial infarction and coronary intervention |
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