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Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention

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Authors:
  • Lamberts, M. ;
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    unknown
  • Gislason, G. H. ;
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    Research Programme on Health and Morbidity in Denmark, National Institute of Public Health, Faculty of Health Sciences, SDU
  • Olesen, J. B. ;
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    unknown
  • Kristensen, S. L. ;
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    CIMT- Centre for Innovative Medical Technology, Department of Clinical Research, Faculty of Health Sciences, SDU
  • Olsen, A. M. S. ;
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    The Maersk Mc-Kinney Moller Institute, Faculty of Engineering, SDU
  • Mikkelsen, A. ;
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    unknown
  • Christensen, C. B. ;
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    Medical Department, Institute of Regional Health Research, Faculty of Health Sciences, SDU
  • Lip, G. Y. H. ;
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    unknown
  • Kober, L. ;
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    unknown
  • Torp-Pedersen, C. ;
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    unknown
  • Hansen, M. L.
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    Clinical Biochemistry, Department of Clinical Research, Faculty of Health Sciences, SDU
Subtitle:
Journal of the American College of Cardiology
DOI:
10.1016/j.jacc.2013.05.029
Abstract:
Objectives The purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI). 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. (C) 2013 by the American College of Cardiology Foundation
Type:
Journal article
Language:
English
Published in:
Journal of the American College of Cardiology, 2013, Vol 62, Issue 11, p. 981-989
Keywords:
antithrombotic treatment atrial fibrillation bleeding myocardial infarction stroke NORTH-AMERICAN PERSPECTIVE LONG-TERM ANTICOAGULATION RE-LY TRIAL ANTITHROMBOTIC THERAPY CONSENSUS DOCUMENT TRIPLE THERAPY NATIONWIDE COHORT EUROPEAN-SOCIETY SYNDROME AND/OR WORKING GROUP; Journal Article; Research Support, Non-U.S. Gov't
Main Research Area:
Medical science
Publication Status:
Published
Review type:
Peer Review
Submission year:
2013
Scientific Level:
Scientific
ID:
244872517

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