Renato D Lopes1, Meena Rao2, DaJuanicia N Simon2, Laine Thomas2, Jack Ansell3, Gregg C Fonarow4, Bernard J Gersh5, Alan S Go6, Elaine M Hylek7, Peter Kowey8, Jonathan P Piccini2, Daniel E Singer9, Paul Chang10, Eric D Peterson2, Kenneth W Mahaffey11. 1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Electronic address: renato.lopes@duke.edu. 2. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. 3. Hofstra North Shore/LIJ School of Medicine, New York, NY. 4. UCLA School of Medicine, Los Angeles, Calif. 5. Mayo Clinic College of Medicine, Rochester, Minn. 6. Kaiser Permanente, Oakland, Calif. 7. Boston University School of Medicine, Mass. 8. Lankenau Institute for Medical Research, Wynnewood, Pa. 9. Harvard Medical School and Massachusetts General Hospital, Boston. 10. Janssen Pharmaceuticals, Raritan, NJ. 11. Stanford University School of Medicine, Calif.
Abstract
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.
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 patientstroke 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.
Authors: Renad M Altoukhi; Reema A Alshouimi; Shahad M Al Rammah; Mohammed Y Alzahrani; Abdulaali R Almutairi; Abdulmajeed M Alshehri; Osamah M Alfayez; Majed S Al Yami; Omar A Almohammed Journal: BMJ Open Date: 2020-09-29 Impact factor: 2.692