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
Language English Country Netherlands Media print-electronic
Document type Comparative Study, Journal Article
PubMed
30220376
DOI
10.1016/j.ijcard.2018.06.098
PII: S0167-5273(18)32449-5
Knihovny.cz E-resources
- Keywords
- Anticoagulants, Antiplatelets, Atrial fibrillation, Bleeding, Coronary artery disease, Major adverse cardiac events, Net clinical benefit,
- MeSH
- Anticoagulants administration & dosage adverse effects MeSH
- Atrial Fibrillation diagnosis drug therapy epidemiology MeSH
- Platelet Aggregation Inhibitors administration & dosage adverse effects MeSH
- Hemorrhage chemically induced diagnosis epidemiology MeSH
- Humans MeSH
- Observational Studies as Topic methods MeSH
- Prospective Studies MeSH
- Registries * MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
- Names of Substances
- Anticoagulants MeSH
- Platelet Aggregation Inhibitors MeSH
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.
Daiichi Sankyo Europe Munich Germany
Department of Cardiology San Maurizio Regional Hospital of Bolzano Italy
Department of Cardiovascular Sciences Campus Bio Medico University of Rome Italy
G d'Annunzio University Chieti Italy
G d'Annunzio University Chieti Italy; Fondazione G Monasterio Pisa Italy
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