Triple vs Dual Antithrombotic Therapy in Patients with Atrial Fibrillation and Coronary Artery Disease - 22/05/16
, Meena Rao, MD a, DaJuanicia N. Simon, MS a, Laine Thomas, PhD a, Jack Ansell, MD b, Gregg C. Fonarow, MD c, Bernard J. Gersh, MB, ChB, DPhil d, Alan S. Go, MD e, Elaine M. Hylek, MD, MPH f, Peter Kowey, MD g, Jonathan P. Piccini, MD, MHS a, Daniel E. Singer, MD h, Paul Chang, MD i, Eric D. Peterson, MD, MPH a, Kenneth W. Mahaffey, MD jAbstract |
Background |
The role of triple antithrombotic therapy vs dual antithrombotic therapy in patients with both atrial fibrillation and coronary artery disease remains unclear. This study explores the differences in treatment practices and outcomes between triple antithrombotic therapy and dual antithrombotic therapy in patients with atrial fibrillation and coronary artery disease.
Methods |
Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (n = 10,135), we analyzed outcomes in patients with coronary artery disease (n = 1827) according to treatment with triple antithrombotic therapy (defined as concurrent therapy with an oral anticoagulant, a thienopyridine, and aspirin) or dual antithrombotic therapy (comprising either an oral anticoagulant and one antiplatelet agent [OAC plus AA] or 2 antiplatelet drugs and no anticoagulant [DAP]).
Results |
The use of triple antithrombotic therapy, OAC plus AA, and DAP at baseline was 8.5% (n = 155), 80.4% (n = 1468), and 11.2% (n = 204), respectively. Among patients treated with OAC plus AA, aspirin was the most common antiplatelet agent used (90%), followed by clopidogrel (10%) and prasugrel (0.1%). The use of triple antithrombotic therapy was not affected by patient risk of either stroke or bleeding. Patients treated with triple antithrombotic therapy at baseline were hospitalized for all causes (including cardiovascular) more often than patients on OAC plus AA (adjusted hazard ratio 1.75; 95% confidence interval, 1.35-2.26; P <.0001) or DAP (hazard ratio 1.82; 95% confidence interval, 1.25-2.65; P = .0018). Rates of major bleeding or a combined cardiovascular outcome were not significantly different by treatment group.
Conclusions |
Choice of antithrombotic therapy in patients with atrial fibrillation and coronary artery disease was not affected by patient stroke or bleeding risks. Triple antithrombotic therapy-treated patients were more likely to be hospitalized for all causes than those on OAC plus AA or on DAP.
Le texte complet de cet article est disponible en PDF.Keywords : Anticoagulants, Antiplatelets, Atrial fibrillation, Combined therapy, Coronary artery disease
Plan
| Funding: The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation is sponsored by Janssen Scientific Affairs, Raritan, NJ. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents. |
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| Conflict of Interest: RDL reports consulting fees and research grants from Bristol-Myers Squibb, research grants from GlaxoSmithKline, and consulting fees from Boehringer-Ingelheim, Bayer, and Pfizer. JA reports consultant/advisory board fees from Bristol-Myers Squibb, Pfizer, Janssen Pharmaceuticals, Daiichi Sankyo, Boehringer-Ingelheim, and Alere. GCF reports consultant/advisory board fees from Ortho McNeil. BJG reports DSMB/advisory board fees from Medtronic, Baxter Healthcare Corporation, InspireMD, Cardiovascular Research Foundation, PPD Development, LP, Boston Scientific, and St. Jude. EMH reports honoraria support from Boehringer-Ingelheim and Bayer; and consultant/advisory board fees from Johnson & Johnson, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Pfizer, and Ortho-McNeil-Janssen. PK reports consultant/advisory board fees from Boehringer-Ingelheim, Bristol-Myers Squibb, Johnson & Johnson, Portola, Merck, Sanofi, and Daiichi Sankyo. JPP reports research grant support from ARCA Biopharma, GE Healthcare, Johnson & Johnson, and ResMed, and consulting fees from Forest Laboratories, Johnson & Johnson, Medtronic and Spectranetics. DES reports research grant support from Johnson & Johnson and Bristol-Myers Squibb, and consultant/advisory board fees from Bayer HealthCare, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Johnson & Johnson, and Pfizer. PC reports employment with Janssen Pharmaceuticals. EDP reports research grant support from Eli Lilly & Company, Janssen Pharmaceuticals, and the American Heart Association; consultant/advisory board support from Boehringer-Ingelheim, Bristol-Myers Squibb, Janssen Pharmaceuticals, Pfizer, and Genentech. KWM's financial disclosures prior to August 1, 2013 can be viewed at Mahaffey-COI_2011-2013.pdf; disclosures after August 1, 2013 can be viewed at kenneth-mahaffey. None of the other authors report disclosures. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 129 - N° 6
P. 592 - juin 2016 Retour au numéro
Article précédent
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