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Outcomes of anticoagulated patients with atrial fibrillation treated with or without antiplatelet therapy - A pooled analysis from the PREFER in AF and PREFER in AF PROLONGATON registries

G. Patti, L. Pecen, M. Lucerna, K. Huber, M. Rohla, G. Renda, J. Siller-Matula, RB. Schnabel, R. Cemin, P. Kirchhof, R. De Caterina,

. 2018 ; 270 (-) : 160-166. [pub] 20180628

Jazyk angličtina Země Nizozemsko

Typ dokumentu srovnávací studie, časopisecké články, metaanalýza

Perzistentní odkaz   https://www.medvik.cz/link/bmc19012374

BACKGROUND: Evidence on whether antiPLT added to OACs is of advantage in atrial fibrillation (AF) patients with concomitant stable coronary artery disease (CAD) is limited. We evaluated clinical outcomes with oral anticoagulant (OAC) monotherapy vs antiplatelet therapy (antiPLT) plus OAC in patients with AF and stable CAD. METHODS: Data on 1058 AF patients on OACs and history (>1 year) of myocardial infarction or coronary stenting were pooled from the PREFER-in-AF and PREFER-in-AF PROLONGATION registries. We primarily compared the 1-year incidence of a net composite endpoint (primary endpoint), including acute coronary syndrome and major bleeding, with or without antiPLT. RESULTS: The incidence of the primary net composite endpoint was significantly higher in patients receiving OACs + antiPLT (N = 348) vs OACs alone (N = 710): 7.9 vs 4.2 per 100 patients/year; adjusted OR [95% CI] 1.84 [1.01-3.37]; p = 0.048. Among the components of the primary endpoint, the greatest relative difference was found for major bleeding (OR [95% CI] 2.28 [95% CI 1.00-5.19]), and especially life-threatening or non-gastrointestinal bleeding. The net clinical outcome with OACs + antiPLT was poorer irrespective of the type of CAD (previous infarction or coronary stenting), the type of stent (bare metal or drug-eluting) or the type of OAC (vitamin K antagonist or non-vitamin K antagonist OAC). CONCLUSIONS: Among patients with AF and stable CAD >1-year after the index event, the addition of antiPLT to OAC does not apparently provide added protection against coronary events, but increases major bleeding. OAC monotherapy should thus be considered the antithrombotic therapy of choice for such patients.

Citace poskytuje Crossref.org

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$a Patti, Giuseppe $u Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy. Electronic address: g.patti@unicampus.it.
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$a Outcomes of anticoagulated patients with atrial fibrillation treated with or without antiplatelet therapy - A pooled analysis from the PREFER in AF and PREFER in AF PROLONGATON registries / $c G. Patti, L. Pecen, M. Lucerna, K. Huber, M. Rohla, G. Renda, J. Siller-Matula, RB. Schnabel, R. Cemin, P. Kirchhof, R. De Caterina,
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$a BACKGROUND: Evidence on whether antiPLT added to OACs is of advantage in atrial fibrillation (AF) patients with concomitant stable coronary artery disease (CAD) is limited. We evaluated clinical outcomes with oral anticoagulant (OAC) monotherapy vs antiplatelet therapy (antiPLT) plus OAC in patients with AF and stable CAD. METHODS: Data on 1058 AF patients on OACs and history (>1 year) of myocardial infarction or coronary stenting were pooled from the PREFER-in-AF and PREFER-in-AF PROLONGATION registries. We primarily compared the 1-year incidence of a net composite endpoint (primary endpoint), including acute coronary syndrome and major bleeding, with or without antiPLT. RESULTS: The incidence of the primary net composite endpoint was significantly higher in patients receiving OACs + antiPLT (N = 348) vs OACs alone (N = 710): 7.9 vs 4.2 per 100 patients/year; adjusted OR [95% CI] 1.84 [1.01-3.37]; p = 0.048. Among the components of the primary endpoint, the greatest relative difference was found for major bleeding (OR [95% CI] 2.28 [95% CI 1.00-5.19]), and especially life-threatening or non-gastrointestinal bleeding. The net clinical outcome with OACs + antiPLT was poorer irrespective of the type of CAD (previous infarction or coronary stenting), the type of stent (bare metal or drug-eluting) or the type of OAC (vitamin K antagonist or non-vitamin K antagonist OAC). CONCLUSIONS: Among patients with AF and stable CAD >1-year after the index event, the addition of antiPLT to OAC does not apparently provide added protection against coronary events, but increases major bleeding. OAC monotherapy should thus be considered the antithrombotic therapy of choice for such patients.
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$a Pecen, Ladislav $u Medical Faculty Pilsen of Charles University, Czech Republic.
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$a Lucerna, Markus $u Daiichi Sankyo Europe, Munich, Germany.
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$a Huber, Kurt $u 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria.
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$a Rohla, Miklos $u 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria.
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$a Renda, Giulia $u G. d'Annunzio University, Chieti, Italy.
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$a Siller-Matula, Jolanta $u Department of Cardiology, Medical University of Vienna, Austria; 1st Department of Cardiology, Poznan University of Medical Sciences, Poland.
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$a Schnabel, Renate B $u University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany.
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$a Cemin, Roberto $u Department of Cardiology, San Maurizio Regional Hospital of Bolzano, Italy.
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$a Kirchhof, Paulus $u Institute of Cardiovascular Sciences, University of Birmingham and SWBH and UHB NHS Trust, Birmingham, UK.
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$a De Caterina, Raffaele $u G. d'Annunzio University, Chieti, Italy; Fondazione G. Monasterio, Pisa, Italy. Electronic address: rdecater@unich.it.
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