Yueh-Hsin Wang1, Hsien-Li Kao2, Chi-Chuan Wang3,4, Shin-Yi Lin3,4, Fang-Ju Lin1,3,4. 1. Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University. 2. Department of Internal Medicine, National Taiwan University Hospital. 3. School of Pharmacy, College of Medicine, National Taiwan University. 4. Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
Abstract
BACKGROUND: There remains insufficient evidence to determine the optimal antithrombotic strategy in atrial fibrillation (AF) patients presenting with acute coronary syndrome (ACS) or percutaneous coronary interventions (PCIs), especially in Asian populations. OBJECTIVES: This study aimed to examine the real-world patterns of antithrombotic treatment among these patients and to compare the effectiveness and safety of different antithrombotic regimens. METHODS: A retrospective cohort study was conducted in AF patients presenting with a new ACS or PCI during 2006/1/1-2016/4/1. Three antithrombotic regimens were compared: dual antiplatelet therapy (DAPT, as the reference group), triple therapy (TT: DAPT plus an oral anticoagulant), and dual therapy (DT: single antiplatelet plus an oral anticoagulant). The outcomes of interest were major adverse cardiac and cerebrovascular events (MACCEs) and bleeding. Treatment effect was estimated using a Cox proportional hazards model. Inverse probability of treatment weighting was used to balance baseline characteristics among comparison groups. RESULTS: Overall, 532 patients were included. At discharge from the index hospitalization, DAPT was the most common antithrombotic therapy, followed by TT and DT. No significant difference in MACCEs was found among the different antithrombotic regimens. However, DT was associated with a lower risk of any bleeding [adjusted hazard ratio 0.20 (95% confidence interval, 0.06-0.75)] than DAPT. CONCLUSIONS: In the study population, DAPT was the most commonly prescribed antithrombotic regimen for cardio-cerebrovascular disease prevention. The effectiveness outcomes were comparable across different antithrombotic strategies. The lower risk of bleeding with DT compared with DAPT warrants further investigation.
BACKGROUND: There remains insufficient evidence to determine the optimal antithrombotic strategy in atrial fibrillation (AF) patients presenting with acute coronary syndrome (ACS) or percutaneous coronary interventions (PCIs), especially in Asian populations. OBJECTIVES: This study aimed to examine the real-world patterns of antithrombotic treatment among these patients and to compare the effectiveness and safety of different antithrombotic regimens. METHODS: A retrospective cohort study was conducted in AF patients presenting with a new ACS or PCI during 2006/1/1-2016/4/1. Three antithrombotic regimens were compared: dual antiplatelet therapy (DAPT, as the reference group), triple therapy (TT: DAPT plus an oral anticoagulant), and dual therapy (DT: single antiplatelet plus an oral anticoagulant). The outcomes of interest were major adverse cardiac and cerebrovascular events (MACCEs) and bleeding. Treatment effect was estimated using a Cox proportional hazards model. Inverse probability of treatment weighting was used to balance baseline characteristics among comparison groups. RESULTS: Overall, 532 patients were included. At discharge from the index hospitalization, DAPT was the most common antithrombotic therapy, followed by TT and DT. No significant difference in MACCEs was found among the different antithrombotic regimens. However, DT was associated with a lower risk of any bleeding [adjusted hazard ratio 0.20 (95% confidence interval, 0.06-0.75)] than DAPT. CONCLUSIONS: In the study population, DAPT was the most commonly prescribed antithrombotic regimen for cardio-cerebrovascular disease prevention. The effectiveness outcomes were comparable across different antithrombotic strategies. The lower risk of bleeding with DT compared with DAPT warrants further investigation.
Authors: Antonia Sambola; Maria Mutuberría; Bruno García Del Blanco; Albert Alonso; José A Barrabés; Fernando Alfonso; Héctor Bueno; Angel Cequier; Javier Zueco; Oriol Rodríguez-Leor; Eduard Bosch; Pilar Tornos; David García-Dorado Journal: Circ J Date: 2015-12-25 Impact factor: 2.993
Authors: Morten L Hansen; Rikke Sørensen; Mette T Clausen; Marie Louise Fog-Petersen; Jakob Raunsø; Niels Gadsbøll; Gunnar H Gislason; Fredrik Folke; Søren S Andersen; Tina K Schramm; Steen Z Abildstrøm; Henrik E Poulsen; Lars Køber; Christian Torp-Pedersen Journal: Arch Intern Med Date: 2010-09-13
Authors: A Sambola; I Ferreira-González; J Angel; F Alfonso; J Maristany; O Rodríguez; H Bueno; J R López-Minguez; J Zueco; F Fernández-Avilés; A San Román; B Prendergast; V Mainar; D García-Dorado; P Tornos Journal: Heart Date: 2009-05-17 Impact factor: 5.994
Authors: Albert Yuh-Jer Shen; Janis F Yao; Somjot S Brar; Michael B Jorgensen; Wansu Chen Journal: J Am Coll Cardiol Date: 2007-07-06 Impact factor: 24.094
Authors: C Michael Gibson; Roxana Mehran; Christoph Bode; Jonathan Halperin; Freek W Verheugt; Peter Wildgoose; Mary Birmingham; Juliana Ianus; Paul Burton; Martin van Eickels; Serge Korjian; Yazan Daaboul; Gregory Y H Lip; Marc Cohen; Steen Husted; Eric D Peterson; Keith A Fox Journal: N Engl J Med Date: 2016-11-14 Impact factor: 91.245