Abstract | OBJECTIVES: BACKGROUND: The optimal antithrombotic treatment strategy is unresolved in patients with multiple indications. METHODS: A total of 12,165 AF patients hospitalized with MI and/or undergoing PCI between 2001 and 2009 were identified by nationwide registries (60.7% male; mean age 75.6 years). Risk of MI/coronary death, ischemic stroke, and bleeding according to antithrombotic treatment regimen was estimated by Cox regression models. RESULTS: Within 1 year, MI or coronary death, ischemic stroke, and bleeding events occurred in 2,255 patients (18.5%), 680 (5.6%), and 769 (6.3%), respectively. Relative to triple therapy (oral anticoagulation [OAC] plus aspirin plus clopidogrel), no increased risk of recurrent coronary events was seen for OAC plus clopidogrel (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.48 to 1.00), OAC plus aspirin (HR: 0.96, 95% CI: 0.77 to 1.19), or aspirin plus clopidogrel (HR: 1.17, 95% CI: 0.96 to 1.42), but aspirin plus clopidogrel was associated with a higher risk of ischemic stroke (HR: 1.50, 95% CI: 1.03 to 2.20). Also, OAC plus aspirin and aspirin plus clopidogrel were associated with a significant increased risk of all-cause death (HR: 1.52, 95% CI: 1.17 to 1.99 and HR: 1.60, 95% CI: 1.25 to 2.05, respectively). When compared to triple therapy, bleeding risk was nonsignificantly lower for OAC plus clopidogrel (HR: 0.78, 95% CI: 0.55 to 1.12) and significantly lower for OAC plus aspirin and aspirin plus clopidogrel. CONCLUSIONS: In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy.
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Authors | Morten Lamberts, Gunnar H Gislason, Jonas Bjerring Olesen, Søren Lund Kristensen, Anne-Marie Schjerning Olsen, Anders Mikkelsen, Christine Benn Christensen, Gregory Y H Lip, Lars Køber, Christian Torp-Pedersen, Morten Lock Hansen |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 62
Issue 11
Pg. 981-9
(Sep 10 2013)
ISSN: 1558-3597 [Electronic] United States |
PMID | 23747760
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Anticoagulants
- Platelet Aggregation Inhibitors
- Clopidogrel
- Ticlopidine
- Aspirin
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Topics |
- Administration, Oral
- Aged
- Aged, 80 and over
- Anticoagulants
(adverse effects, therapeutic use)
- Aspirin
(adverse effects, therapeutic use)
- Atrial Fibrillation
(complications, therapy)
- Clopidogrel
- Denmark
(epidemiology)
- Drug Therapy, Combination
- Female
- Humans
- Incidence
- Male
- Myocardial Infarction
(epidemiology, etiology, prevention & control)
- Percutaneous Coronary Intervention
- Platelet Aggregation Inhibitors
(adverse effects, therapeutic use)
- Postoperative Complications
- Registries
- Risk Factors
- Ticlopidine
(adverse effects, analogs & derivatives, therapeutic use)
- Treatment Outcome
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