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Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention

Journal of the American College of Cardiology, 2013-09, Vol.62 (11), p.981-989 [Peer Reviewed Journal]

American College of Cardiology Foundation ;2013 American College of Cardiology Foundation ;2014 INIST-CNRS ;Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Sep 10, 2013 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2013.05.029 ;PMID: 23747760 ;CODEN: JACCDI

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Title:
Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention
Author: Lamberts, Morten, MD ; Gislason, Gunnar H., MD, PhD ; Olesen, Jonas Bjerring, MD ; Kristensen, Søren Lund, MD ; Schjerning Olsen, Anne-Marie, MD ; Mikkelsen, Anders, MB ; Christensen, Christine Benn, MD ; Lip, Gregory Y.H., MD ; Køber, Lars, MD, DMS ; Torp-Pedersen, Christian, MD, DMS ; Hansen, Morten Lock, MD, PhD
Subjects: Administration, Oral ; Aged ; Aged, 80 and over ; Anticoagulants ; Anticoagulants - adverse effects ; Anticoagulants - therapeutic use ; antithrombotic treatment ; Aspirin - adverse effects ; Aspirin - therapeutic use ; atrial fibrillation ; Atrial Fibrillation - complications ; Atrial Fibrillation - therapy ; Biological and medical sciences ; bleeding ; Blood. Blood coagulation. Reticuloendothelial system ; Cardiac dysrhythmias ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Coronary heart disease ; Denmark - epidemiology ; Diseases of the cardiovascular system ; Drug therapy ; Drug Therapy, Combination ; Female ; Heart ; Heart attacks ; Humans ; Incidence ; Internal Medicine ; Male ; Medical sciences ; myocardial infarction ; Myocardial Infarction - epidemiology ; Myocardial Infarction - etiology ; Myocardial Infarction - prevention & control ; Percutaneous Coronary Intervention ; Pharmacology. Drug treatments ; Platelet Aggregation Inhibitors - adverse effects ; Platelet Aggregation Inhibitors - therapeutic use ; Postoperative Complications ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Registries ; Risk Factors ; Stroke ; Ticlopidine - adverse effects ; Ticlopidine - analogs & derivatives ; Ticlopidine - therapeutic use ; Treatment Outcome
Is Part Of: Journal of the American College of Cardiology, 2013-09, Vol.62 (11), p.981-989
Description: Objectives 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). Background The optimal antithrombotic treatment strategy is unresolved in patients with multiple indications. Methods 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. Results 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. Conclusions 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.
Publisher: New York, NY: Elsevier Inc
Language: English
Identifier: ISSN: 0735-1097
EISSN: 1558-3597
DOI: 10.1016/j.jacc.2013.05.029
PMID: 23747760
CODEN: JACCDI
Source: GFMER Free Medical Journals
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Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention

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