Caroline Sindet-Pedersen 1,2,3 , Laila Staerk 1,2 , Morten Lamberts 1 , Thomas Alexander Gerds 4,5 , Jeffrey S Berger 3 , Anders Nissen Bonde 1,2 , Jannik Langtved Pallisgaard 1,2 , Morten Lock Hansen 1 , Christian Torp-Pedersen 1,6 , Gunnar H Gislason 1,2,4,7 , Jonas Bjerring Olesen 1 Show Affiliations »
Abstract
OBJECTIVES: To investigate temporal trends in the use of non-vitamin K oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) in combination with aspirin and/or clopidogrel in patients with atrial fibrillation (AF) following acute myocardial infarction (MI) and/or percutaneous coronary intervention (PCI). METHODS: Using Danish nationwide registries, all patients with AF who survived 30 days after discharge from MI and/or PCI between 22 August 2011 and 30 September 2016 were identified. RESULTS: A total of 2946 patients were included in the study population, of whom 1967 (66.8%) patients were treated with VKA in combination with antiplatelet(s) (VKA+aspirin n=477, VKA+clopidogrel n=439, VKA+aspirin+clopidogrel n=1051) and 979 (33.2%) patients were treated with NOAC in combination with antiplatelet(s) (NOAC+aspirin n=252, NOAC+clopidogrel n=218, NOAC+aspirin+clopidogrel n=509). The overall study population had a median age of 76 years [IQR: 69-82] and consisted of 1995 (67.7%) men. Patients with MI as inclusion event accounted for 1613 patients (54.8%). Patients with high CHA2DS2-VASc score(congestive heart failure, hypertension, age ≥75 years (2 points), diabetes mellitus, history of stroke/transient ischemic attack/systemic thromboembolism (2 points), vascular disease, age 65-75 years, and female sex) accounted for 132 2814 (95.5%) of patients, and patients with high HAS-BLED score (hypertension, abnormal renal/liver function, history of stroke, history of bleeding, age >65 years, non-steroidal anti-inflammatory drug usages, or alcohol abuse, leaving out labile international normalized ratio (not available), and use of antiplatelets (exposure variable)) accounted for 934 (31.7%) of patients. There was an increase from 10% in 2011 to 52% in 2016 in the use of NOACs in combination with antiplatelet(s). CONCLUSION: From 2011 to 2016, the use of NOAC in combination with antiplatelet(s) increased in patients with AF following MI/PCI and exceeded the use of VKA in combination with antiplatelet(s) by 2016. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
OBJECTIVES: To investigate temporal trends in the use of non-vitamin K oral anticoagulants (NOACs ) and vitamin K antagonists (VKAs) in combination with aspirin and/or clopidogrel in patients with atrial fibrillation (AF ) following acute myocardial infarction (MI) and/or percutaneous coronary intervention (PCI). METHODS: Using Danish nationwide registries, all patients with AF who survived 30 days after discharge from MI and/or PCI between 22 August 2011 and 30 September 2016 were identified. RESULTS: A total of 2946 patients were included in the study population, of whom 1967 (66.8%) patients were treated with VKA in combination with antiplatelet(s) (VKA+aspirin n=477, VKA+clopidogrel n=439, VKA+aspirin +clopidogrel n=1051) and 979 (33.2%) patients were treated with NOAC in combination with antiplatelet(s) (NOAC+aspirin n=252, NOAC+clopidogrel n=218, NOAC+aspirin +clopidogrel n=509). The overall study population had a median age of 76 years [IQR: 69-82] and consisted of 1995 (67.7%) men . Patients with MI as inclusion event accounted for 1613 patients (54.8%). Patients with high CHA2DS2-VASc score(congestive heart failure , hypertension , age ≥75 years (2 points), diabetes mellitus , history of stroke /transient ischemic attack/systemic thromboembolism (2 points), vascular disease , age 65-75 years, and female sex) accounted for 132 2814 (95.5%) of patients , and patients with high HAS-BLED score (hypertension , abnormal renal/liver function, history of stroke , history of bleeding , age >65 years, non-steroidal anti-inflammatory drug usages, or alcohol abuse , leaving out labile international normalized ratio (not available), and use of antiplatelets (exposure variable)) accounted for 934 (31.7%) of patients . There was an increase from 10% in 2011 to 52% in 2016 in the use of NOACs in combination with antiplatelet(s). CONCLUSION: From 2011 to 2016, the use of NOAC in combination with antiplatelet(s) increased in patients with AF following MI/PCI and exceeded the use of VKA in combination with antiplatelet(s) by 2016. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Entities: Chemical
Disease
Species
Keywords:
acute myocardial infarction; atrial fibrillation; drug monitoring; percutaneous coronary intervention
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Year: 2017
PMID： 29092916 DOI： 10.1136/heartjnl-2017-311976
Source DB: PubMed Journal: Heart ISSN： 1355-6037 Impact factor: 5.994