Tuomas Kiviniemi1, K E Juhani Airaksinen2, Andrea Rubboli3, Fausto Biancari4, Josè Valencia5, Gregory Y H Lip6, Pasi P Karjalainen7, Michael Weber8, Mika Laine9, Paulus Kirchhof10, Axel Schlitt11. 1. Heart Center, Turku University Hospital and University of Turku, Finland. Electronic address: tuomas.kiviniemi@utu.fi. 2. Heart Center, Turku University Hospital and University of Turku, Finland. 3. Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy. 4. Department of Surgery, Oulu University Hospital, Finland. 5. Department of Cardiology, General Hospital University of Alicante, Spain. 6. University of Birmingham Centre for Cardiovascular Sciences, City Hospital, UK. 7. Satakunta Central Hospital, Finland. 8. Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany. 9. Department of Medicine, Division of Cardiology, Helsinki University Hospital, Finland. 10. Department of Cardiology and Angiology, University Hospital Münster, Germany; University of Birmingham Centre for Cardiovascular Sciences, City Hospital, UK. 11. Medical Faculty, Martin Luther-University Halle, Germany; Department of Cardiology, Paracelsus Harz-Clinic Bad Suderode, Germany.
Abstract
BACKGROUND: Recent reports have provided evidence that bridging therapy with low-molecular-weight heparin (LMWH) may increase bleeding complications in patients with atrial fibrillation (AF) on oral anticoagulation undergoing percutaneous coronary intervention (PCI). We sought to assess mid-term bleeding and thromboembolic events in patients from the AFCAS registry discharged on triple therapy (TT). METHODS: AFCAS is a multicenter, prospective registry enrolling patients with AF undergoing PCI. The primary endpoints were: 1) bleeding complications as defined by the bleeding academic research criteria (BARC); 2) a composite of cardiac and cerebrovascular events (MACCE) at 3 and 12 month follow-ups. RESULTS: Altogether 663 out of 929 consecutive patients were discharged on TT, either on oral vitamin K antagonist (VKA-TT) (n=498) or bridging LMWH-TT (n=165). Patients on LMWH-TT had more often diabetes, heart failure, and hypertension compared to those on VKA-TT. The rates of major bleeding events (BARC≥3) (11.5% vs. 6.0%, p=0.03) as well as MACCE (11.5% vs. 5.0%, p=0.006) were higher in the LMWH-TT group compared to VKA-TT group at 3 months follow-up. In a Cox multivariate regression model and propensity-score matched analysis LMWH-TT increased the risk for major BARC bleeding events at 3 and 12 month follow-ups. CONCLUSIONS: In this large, prospective, real-world population of patients with AF undergoing PCI patients discharged on LMWH-TT had a significantly higher risk for major bleeds in comparison to patients discharged on VKA-TT. LMWH-bridging therapy appeared harmful in this subset of patient on oral anticoagulation.
BACKGROUND: Recent reports have provided evidence that bridging therapy with low-molecular-weight heparin (LMWH) may increase bleeding complications in patients with atrial fibrillation (AF) on oral anticoagulation undergoing percutaneous coronary intervention (PCI). We sought to assess mid-term bleeding and thromboembolic events in patients from the AFCAS registry discharged on triple therapy (TT). METHODS: AFCAS is a multicenter, prospective registry enrolling patients with AF undergoing PCI. The primary endpoints were: 1) bleeding complications as defined by the bleeding academic research criteria (BARC); 2) a composite of cardiac and cerebrovascular events (MACCE) at 3 and 12 month follow-ups. RESULTS: Altogether 663 out of 929 consecutive patients were discharged on TT, either on oral vitamin K antagonist (VKA-TT) (n=498) or bridging LMWH-TT (n=165). Patients on LMWH-TT had more often diabetes, heart failure, and hypertension compared to those on VKA-TT. The rates of major bleeding events (BARC≥3) (11.5% vs. 6.0%, p=0.03) as well as MACCE (11.5% vs. 5.0%, p=0.006) were higher in the LMWH-TT group compared to VKA-TT group at 3 months follow-up. In a Cox multivariate regression model and propensity-score matched analysis LMWH-TT increased the risk for major BARC bleeding events at 3 and 12 month follow-ups. CONCLUSIONS: In this large, prospective, real-world population of patients with AF undergoing PCI patients discharged on LMWH-TT had a significantly higher risk for major bleeds in comparison to patients discharged on VKA-TT. LMWH-bridging therapy appeared harmful in this subset of patient on oral anticoagulation.
Authors: Antti Palomäki; Tuomas Kiviniemi; Juha E K Hartikainen; Pirjo Mustonen; Antti Ylitalo; Ilpo Nuotio; Päivi Hartikainen; Jussi Jaakkola; Riho Luite; K E Juhani Airaksinen Journal: Clin Cardiol Date: 2016-05-30 Impact factor: 2.882
Authors: E Schneck; F K Schneck; J S Wolter; C W Hamm; V Mann; H Hauch; B Kemkes-Matthes; J T Gräsner; H V Groesdonk; D Dirkmann; M Sander; C Koch; F Brenck Journal: Anaesthesist Date: 2019-12-04 Impact factor: 1.041
Authors: Jussi Jaakkola; Pirjo Mustonen; Tuomas Kiviniemi; Juha E K Hartikainen; Antti Palomäki; Päivi Hartikainen; Ilpo Nuotio; Antti Ylitalo; K E Juhani Airaksinen Journal: PLoS One Date: 2016-12-09 Impact factor: 3.240