Antiplatelet Therapy for Stable Coronary Artery Disease in Atrial Fibrillation Patients Taking an Oral Anticoagulant A Nationwide Cohort Study

Bidragets oversatte titel: Antiplatelet Therapy for Stable Coronary Artery Disease in Atrial Fibrillation Patients Taking an Oral Anticoagulant A Nationwide Cohort Study

M. Lamberts, G. H. Gislason, G. Y. H. Lip, J. F. Lassen, J. B. Olesen, A. P. Mikkelsen, R. Sorensen, L. Kober, C. Torp-Pedersen, M. L. Hansen

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    Abstrakt

    Background The optimal long-term antithrombotic treatment of patients with coexisting atrial fibrillation and stable coronary artery disease is unresolved, and commonly, a single antiplatelet agent is added to oral anticoagulation. We investigated the effectiveness and safety of adding antiplatelet therapy to vitamin K antagonist (VKA) in atrial fibrillation patents with stable coronary artery disease. Methods and Results Atrial fibrillation patients with stable coronary artery disease (defined as 12 months from an acute coronary event) between 2002 and 2011 were identified. The subsequent risk of cardiovascular events and serious bleeding events (those that required hospitalization) was examined with adjusted Cox regression models according to ongoing antithrombotic therapy. A total of 8700 patients were included (mean age, 74.2 years; 38% women). During a mean follow-up of 3.3 years, crude incidence rates were 7.2, 3.8, and 4.0 events per 100 person-years for myocardial infarction/coronary death, thromboembolism, and serious bleeding, respectively. Relative to VKA monotherapy, the risk of myocardial infarction/coronary death was similar for VKA plus aspirin (hazard ratio, 1.12 [95% confidence interval, 0.94-1.34]) and VKA plus clopidogrel (hazard ratio, 1.53 [95% confidence interval, 0.93-2.52]). The risk of thromboembolism was comparable in all regimens that included VKA, whereas the risk of bleeding increased when aspirin (hazard ratio, 1.50 [95% confidence interval, 1.23-1.82]) or clopidogrel (hazard ratio, 1.84 [95% confidence interval, 1.11-3.06]) was added to VKA. Conclusions In atrial fibrillation patients with stable coronary artery disease, the addition of antiplatelet therapy to VKA therapy is not associated with a reduction in risk of recurrent coronary events or thromboembolism, whereas risk of bleeding is increased significantly. The common practice of adding antiplatelet therapy to oral VKA anticoagulation in patients with atrial fibrillation and stable coronary artery disease warrants reassessment.
    Bidragets oversatte titelAntiplatelet Therapy for Stable Coronary Artery Disease in Atrial Fibrillation Patients Taking an Oral Anticoagulant A Nationwide Cohort Study
    OriginalsprogEngelsk
    TidsskriftCirculation
    Vol/bind129
    Udgave nummer15
    Sider (fra-til)1577-1585
    ISSN0009-7322
    DOI
    StatusUdgivet - 2014

    Bibliografisk note

    ISI Document Delivery No.: AE9II Times Cited: 12 Cited Reference Count: 33 Lamberts, Morten Gislason, Gunnar H. Lip, Gregory Y. H. Lassen, Jens Flensted Olesen, Jonas Bjerring Mikkelsen, Anders P. Sorensen, Rikke Kober, Lars Torp-Pedersen, Christian Hansen, Morten Lock Department of Cardiology, Gentofte University Hospital; Novo Nordisk Foundation Dr Lamberts is supported by an unrestricted grant from the Department of Cardiology, Gentofte University Hospital. Dr Gislason is supported by an unrestricted clinical research scholarship from the Novo Nordisk Foundation. 12 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA CIRCULATION

    Citationsformater