Oscar Ö Braun1, Besim Bico2, Uzma Chaudhry3, Henrik Wagner4, Sasha Koul5, Patrik Tydén6, Fredrik Scherstén7, Stefan Jovinge8, Peter J Svensson9, J Gustav Smith10, Jesper van der Pals11. 1. Department of Cardiology, Skåne University Hospital, Lund University, Lund and Malmö, Sweden. Electronic address: oscar.braun@med.lu.se. 2. Department of Cardiology, Skåne University Hospital, Lund University, Lund and Malmö, Sweden. Electronic address: besim.bico@med.lu.se. 3. Department of Internal Medicine, Helsingborg Hospital, Lund University, Lund and Helsingborg, Sweden. Electronic address: uzma9c@hotmail.com. 4. Department of Internal Medicine, Helsingborg Hospital, Lund University, Lund and Helsingborg, Sweden. Electronic address: henrik.wagner@med.lu.se. 5. Department of Cardiology, Skåne University Hospital, Lund University, Lund and Malmö, Sweden. Electronic address: sasha.koul@med.lu.se. 6. Department of Cardiology, Skåne University Hospital, Lund University, Lund and Malmö, Sweden. Electronic address: patrik.tyden@skane.se. 7. Department of Cardiology, Skåne University Hospital, Lund University, Lund and Malmö, Sweden. Electronic address: fredrik.schersten@skane.se. 8. Department of Cardiology, Skåne University Hospital, Lund University, Lund and Malmö, Sweden. Electronic address: stefan.jovinge@med.lu.se. 9. Department for Coagulation Disorders, Skåne University Hospital, Lund University, Lund and Malmö, Sweden. Electronic address: peter.svensson@med.lu.se. 10. Department of Cardiology, Skåne University Hospital, Lund University, Lund and Malmö, Sweden. Electronic address: gustav.smith@med.lu.se. 11. Department of Cardiology, Skåne University Hospital, Lund University, Lund and Malmö, Sweden. Electronic address: jesper.vanderpals@med.lu.se.
Abstract
INTRODUCTION: Treatment with warfarin in combination with clopidogrel has been shown to reduce the incidence of major bleeding as compared to triple antithrombotic therapy (TT; warfarin, clopidogrel and aspirin). However, there are uncertainties regarding the risk for thrombosis since poor-responsiveness to clopidogrel is common. Ticagrelor is a more potent platelet inhibitor, but data supporting concurrent use of ticagrelor and warfarin (dual antithrombotic therapy, DT) is limited. This study therefore sought to evaluate the risk of bleeding and thrombosis associated with DT after an acute coronary syndrome (ACS). MATERIALS AND METHODS: We identified all ACS patients on DT upon discharge from Helsingborg Hospital and Skåne University Hospital in Malmö and Lund, Sweden, during 2013. Patients on DT were compared with historical controls discharged with TT. Major bleeding was defined in accordance with the HAS-BLED derivation study. Patients were retrospectively followed for three months. RESULTS: In total, 107 DT patients were identified and compared with 159 controls on TT. Mean HAS-BLED bleeding risk score and duration of treatment were similar between the groups (HAS-BLED 2.2+/-0.8 vs 2.2+/-1.0 units, p=NS; duration 2.7+/-0.8 vs 2.5+/-0.9months, p=NS; DT vs TT). The incidence of spontaneous major bleeding was similar between the groups, as was a composite of all thrombotic events, i.e. peripheral embolism, stroke/TIA and acute coronary syndrome (bleeding 8/106 (7.5%) vs 11/157 (7.0%), p=NS; thrombosis 5/106 (4.7%) vs 5/157 (3.2%), p=NS; DT vs TT). CONCLUSIONS: Rates of thrombotic and bleeding events were similar in patients with TT and patients with ticagrelor and warfarin.
INTRODUCTION: Treatment with warfarin in combination with clopidogrel has been shown to reduce the incidence of major bleeding as compared to triple antithrombotic therapy (TT; warfarin, clopidogrel and aspirin). However, there are uncertainties regarding the risk for thrombosis since poor-responsiveness to clopidogrel is common. Ticagrelor is a more potent platelet inhibitor, but data supporting concurrent use of ticagrelor and warfarin (dual antithrombotic therapy, DT) is limited. This study therefore sought to evaluate the risk of bleeding and thrombosis associated with DT after an acute coronary syndrome (ACS). MATERIALS AND METHODS: We identified all ACS patients on DT upon discharge from Helsingborg Hospital and Skåne University Hospital in Malmö and Lund, Sweden, during 2013. Patients on DT were compared with historical controls discharged with TT. Major bleeding was defined in accordance with the HAS-BLED derivation study. Patients were retrospectively followed for three months. RESULTS: In total, 107 DTpatients were identified and compared with 159 controls on TT. Mean HAS-BLED bleeding risk score and duration of treatment were similar between the groups (HAS-BLED 2.2+/-0.8 vs 2.2+/-1.0 units, p=NS; duration 2.7+/-0.8 vs 2.5+/-0.9months, p=NS; DT vs TT). The incidence of spontaneous major bleeding was similar between the groups, as was a composite of all thrombotic events, i.e. peripheral embolism, stroke/TIA and acute coronary syndrome (bleeding 8/106 (7.5%) vs 11/157 (7.0%), p=NS; thrombosis 5/106 (4.7%) vs 5/157 (3.2%), p=NS; DT vs TT). CONCLUSIONS: Rates of thrombotic and bleeding events were similar in patients with TT and patients with ticagrelor and warfarin.
Authors: Florentino Lupercio; Shaun Giancaterino; Pedro Arturo Villablanca; Frederick Han; Kurt Hoffmayer; Gordon Ho; Farshad Raissi; David Krummen; Ulrika Birgersdotter-Green; Gregory Feld; Ryan Reeves; Ehtisham Mahmud; Jonathan C Hsu Journal: Heart Date: 2020-02-07 Impact factor: 5.994
Authors: Sasha Gulati; Ole Solheim; Sven M Carlsen; Lise R Øie; Heidi Jensberg; Agnete M Gulati; Mattis A Madsbu; Charalampis Giannadakis; Asgeir S Jakola; Øyvind Salvesen Journal: PLoS One Date: 2018-08-23 Impact factor: 3.240
Authors: Michał J Kubisa; Mateusz P Jezewski; Aleksandra Gasecka; Jolanta M Siller-Matula; Marek Postuła Journal: Ther Clin Risk Manag Date: 2018-01-17 Impact factor: 2.423