Antiplatelet Therapy for Stable Coronary Artery Disease in Atrial Fibrillation Patients Taking an Oral Anticoagulant

Lamberts, Morten; Gislason, Gunnar; Lip, Gregory Y.H.; Lassen, Jens Flensted; Olesen, Jonas Bjerring; Mikkelsen, A. B.; Sørensen, Rikke; Køber, Lars; Torp‐Pedersen, Christian; Hansen, Morten Lock

doi:10.1161/circulationaha.113.004834

Cited by 255 publications

(172 citation statements)

References 34 publications

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“…Debe considerarse el tratamiento doble con un AVK y clopidogrel (75 mg/día) como alternativa al tratamiento triple durante 1 mes para los pacientes cuyo riesgo hemorrágico sea superior al isquémico 183,184 IIa A Para pacientes tratados con ICP, debe considerarse la suspensión del tratamiento antiagregante a los 12 meses 185 IIa B Para los pacientes que requieren ácido acetilsalicílico o clopidogrel además de un AVK, se debe regular cuidadosamente la intensidad de la dosis de AVK con un objetivo de INR en la parte inferior del intervalo recomendado y con un tiempo en rango terapéutico > 65-70% 182,184 IIa B…”

Section: Prótesis Mecánicasunclassified

Guía ESC/EACTS 2017 sobre el tratamiento de las valvulopatías

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología

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Section: Prótesis Mecánicasunclassified

Guía ESC/EACTS 2017 sobre el tratamiento de las valvulopatías

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología

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“…Though oral anticoagulants are more effective than antiplatelet agents in preventing stroke/SEE in patients with AF, it is thought that the latter may be more protective in reducing vascular events in patients with CAD or at high risk of acute coronary events 4, 5. The choice of optimal antithrombotic management to prevent both thromboembolic and acute ischemic events in patients with AF and coexisting CAD is challenging given that combination therapy of anticoagulant and ‐antiplatelet agents is associated with an increased risk of bleeding and its efficacy is not clear 6, 7, 8, 9, 10. Here, we report on the effects of single antiplatelet therapy (SAPT) on the comparison of edoxaban with warfarin in patients with non‐valvular AF.…”

Section: Introductionmentioning

confidence: 99%

Concomitant Use of Single Antiplatelet Therapy With Edoxaban or Warfarin in Patients With Atrial Fibrillation: Analysis From the ENGAGE AF‐TIMI48 Trial

Ruff

Giugliano

et al. 2016

JAHA

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BackgroundWe studied the concomitant use of single antiplatelet therapy (SAPT) on the efficacy and safety of the anti‐Xa agent edoxaban in patients with atrial fibrillation (AF).Methods and Results ENGAGE AF‐TIMI 48 was a randomized trial that compared 2 dose regimens of edoxaban with warfarin. We studied both the approved high‐dose edoxaban regimen (HDER; 60 mg daily reduced by one half in patients with anticipated increased drug exposure), as well as a lower‐dose edoxaban regimen (LDER; 30 mg daily, also reduced by one half in patients with anticipated increased drug regimen). SAPT (aspirin in 92.5%) was administered at the discretion of the treating physician. Cox proportional hazard regressions stratified by SAPT at 3 months with treatment as a covariate were performed. The 4912 patients who received SAPT were more frequently male, with histories of coronary artery disease and diabetes, and had higher CHADS 2Vasc and HAS BLED scores than did the 14 977 patients not receiving SAPT. When compared to patients not receiving SAPT, those receiving SAPT had a higher incidence of major bleeding; (adjusted hazard ratio [HR adj]=1.46; 95% CI, 1.27–1.67, P<0.001). SAPT did not alter the relative efficacy of edoxaban compared to warfarin in preventing stroke or systemic embolic events (SEEs): edoxaban versus warfarin without SAPT, hazard ratio (HR adj for HDER)=0.94; (95% CI: 0.77–1.15) with SAPT, HR adj=0.70 (95% CI: 0.50–0.98), P interaction (P int)=0.14. (HR adj for LDER versus warfarin without SAPT=1.19 (95% CI 0.99–1.43) With SAPT, 1.03 (95% CI, 0.76–1.39) P int=0.42. Major bleeding was lower with edoxaban than warfarin both without SAPT, HR adj for HDER=0.80 (95% CI, 0.68–0.95), and with SAPT, HR adj=0.82 (95% CI, 0.65–1.03; P int=0.91). For LDER without SAPT (HR adj=0.56 [95% CI 0.46–0.67]) and with SAPT (HR adj=0.51 [95% CI 0.39–0.66]).ConclusionsPatients with AF who were selected by their physicians to receive SAPT in addition to an anticoagulant had a similar risk of stroke/SEE and higher rates of bleeding than those not receiving SAPT. Edoxaban exhibited similar relative efficacy and reduced bleeding compared to warfarin, with or without concomitant SAPT.Clinical Trial Registration URL: http://www.clinicaltrials.gov/. Unique identifier: NCT00781391.

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“…The study has been interpreted by some as proof that the duration of TT can be safely shortened; however; we caution against assuming noninferiority from an underpowered trial designed to shown superiority. 38 demonstrated that in AF patients with stable CAD, the addition of antiplatelet therapy to VKA therapy was not associated with a reduction in risk of recurrent coronary events or thromboembolism, whereas risk of bleeding was increased significantly. The common practice of adding antiplatelet therapy to oral VKA anticoagulation in patients with AF and stable CAD warrants reassessment.…”

Section: Picard Et Al Triple Therapy For Af Patients Undergoing Pcimentioning

confidence: 97%

Triple Antithrombotic Therapy in Atrial Fibrillation Patients With an Indication for Oral Anticoagulation Undergoing Percutaneous Coronary Intervention

Picard

Tadros

Asgar

2015

Circ: Cardiovascular Interventions

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DiscussionDr Picard: How common are patients like the one described and what are the therapeutic challenges for such patients undergoing PCI?Dr Asgar: Approximately 5% to 8% of patients undergoing PCI and stenting have an indication for long-term oral anticoagulation (OAC) because of AF. 7,8 Obviously, the main concern is to prevent death and disability for our patients. The challenge is finding the optimal balance between preventing thromboembolic events, such as thromboembolic stroke without increasing bleeding risk post-PCI. Chronic OAC is recommended in patients with AF and a CHA 2 DS 2 -VASc score ≥1, 4 and ≈30% of AF patients have concomitant CAD.

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Antiplatelet Therapy for Stable Coronary Artery Disease in Atrial Fibrillation Patients Taking an Oral Anticoagulant

Abstract: declined, and VKA alone is now recommended in AF patients who are >1 year from an acute coronary event or revascularization procedure.8 New data also suggest that MI risk could actually increase with the addition of multiple antiplatelets to oral anticoagulation treatment.

Cited by 255 publications

References 34 publications

Guía ESC/EACTS 2017 sobre el tratamiento de las valvulopatías

Guía ESC/EACTS 2017 sobre el tratamiento de las valvulopatías

Concomitant Use of Single Antiplatelet Therapy With Edoxaban or Warfarin in Patients With Atrial Fibrillation: Analysis From the ENGAGE AF‐TIMI48 Trial

Triple Antithrombotic Therapy in Atrial Fibrillation Patients With an Indication for Oral Anticoagulation Undergoing Percutaneous Coronary Intervention

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