Characteristics and antithrombotic treatment patterns of patients with concomitant coronary artery disease and atrial fibrillation from Thailand’s COOL-AF registry

Winijkul, Arjbordin; Kaewkumdee, Pontawee; Yindeengam, Ahthit; Krittayaphong, Rungroj

doi:10.1186/s12872-021-01928-4

Cited by 2 publications

(4 citation statements)

References 27 publications

(30 reference statements)

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“…However, the application of OACs in the present elderly patients with ACS and AF conferred a 4 times lower risk of death, without an increase in bleeding. Similar efficacy of OACs was found in elderly individuals with AF ( 21 , 30 , 32 ). Therefore, greater efforts to improve the prescription of OACs in the elderly are necessary, especially among older subjects with ACS and AF.…”

Section: Discussionsupporting

confidence: 77%

“…Similar efficacy of OACs was found in elderly individuals with AF (21,30,32). Therefore, greater efforts to improve the prescription of OACs in the elderly are necessary, especially among older subjects with ACS and AF.…”

Section: Discussionmentioning

confidence: 62%

“…The reason for the underutilization of OACs in the present study could be attributed to the factors age, type of AF, AMI, PCI, and the concomitant use of DAPT. As we know, physicians in real-world clinical practice are reluctant to discontinue antiplatelet treatment, especially among PCI-treated ACS patients with AF, therefore discouraging physicians from prescribing OACs ( 30 ). In addition, elderly patients who presented with both ACS and AF were more likely to be prescribed DAPT rather than OAC by physicians ( 21 , 31 ).…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Antithrombotic Therapy With Oral Anticoagulants in Real-World Elderly Patients With Acute Coronary Syndrome and Atrial Fibrillation

Li²,

Qin³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe efficacy and safety of antithrombotic treatment with oral anticoagulants (OACs) in elderly patients with comorbidities of acute coronary syndrome (ACS) and atrial fibrillation (AF) are unclear.MethodsA cohort of hospitalized elderly patients (≥65 years of age) diagnosed with ACS and AF and treated with oral antithrombotic agents were consecutively recruited. Follow-up was performed for at least 1 year. Major adverse cardiac events (MACEs) were defined as a composite of all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, and systemic embolism. The safety outcomes of bleeding were defined according to the Bleeding Academic Research Consortium (BARC) criteria.ResultsA cohort of 548 eligible patients (76 ± 6.6 years) was analyzed. Compared to the patients with OAC treatment (n = 184, 33.6%), patients treated without OAC (n = 364, 66.4%) were older, had a lower prevalence of persistent AF and unstable angina (UA), and more often presented with paroxysmal AF, acute myocardial infarction (AMI), stent implantation and dual antiplatelet therapy (DAPT). Compared to the patients without OAC treatment (n = 364, 66.4%), patients treated with OAC (n = 184, 33.6%) had a lower risk of MACEs at both the 1-year (4.3 vs. 15.1%, adjusted HR: 0.34, 95% CI: 0.15–0.80, p = 0.014) and 5-year (17.5 vs. 48.4%, adjusted HR: 0.36, 95% CI: 0.19–0.67, p = 0.001) follow-up. No significant difference was observed for bleeding events of BARC ≥2 between the groups (8.0 vs. 9.0%, adjusted HR: 1.17, 95% CI: 0.58–2.34, p = 0.667). Compared with warfarin-treated patients, the non-vitamin K antagonist oral anticoagulant-treated patients had lower risks of all-cause mortality (2.1 vs. 9.5%, HR: 0.18, 95% CI: 0.03–0.98, p = 0.047) and bleeding events of BARC ≥ 3 (2.1 vs. 4.8%, HR: 0.14, 95% CI: 0.02–1.10, p = 0.062).ConclusionsAntithrombotic therapy with OACs in elderly patients with ACS and AF was associated with a lower risk of ischemic events without an increase in bleeding events. In real-world practice, the clinical awareness of anticoagulation treatments in elderly patients with ACS and AF needs to be strengthened.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Antithrombotic Therapy With Oral Anticoagulants in Real-World Elderly Patients With Acute Coronary Syndrome and Atrial Fibrillation

Li²,

Qin³

et al. 2022

Front. Cardiovasc. Med.

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“…The effectiveness of oral OAC in elderly patients with SCAD and AF is reflected mainly by the more than 5 times absolute decrease in all-cause mortality, including an approximately 3 times decrease in cardiac death. A similar efficacy of OAC treatment was reported in elderly patients with AF [ 24 , 29 , 30 ].…”

Section: Discussionsupporting

confidence: 77%

Efficacy and safety of oral anticoagulants in elderly patients with stable coronary artery disease and atrial fibrillation

Zhang

et al. 2022

Thrombosis J

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Background This study aimed to evaluate the efficacy and safety of oral anticoagulants (OACs) in real-world elderly patients with comorbidities of stable coronary artery disease (SCAD) and atrial fibrillation (AF). Methods Elderly patients (aged ≥ 65 years old) diagnosed with SCAD and AF were consecutively recruited and grouped into patients with or without oral anticoagulant (OAC) treatment. Follow-up was performed for 5 years. Major adverse cardiac events (MACEs) were defined as a composite of all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, and systemic embolism. Major bleeding outcomes were defined as events that were type ≥ 3 based on the Bleeding Academic Research Consortium (BARC) criteria. The net clinical outcomes were defined as the combination of MACEs and bleeding of BARC type ≥ 3. Results A cohort of 832 eligible patients (78 ± 6.70 years) was included. Compared to the patients without OAC treatment (n = 531, 63.82%), the patients treated with OAC (n = 301, 36.18%) were much younger, had higher body mass index (BMI), and had lower prevalence of heart failure, chronic obstructive pulmonary disease (COPD), renal insufficiency, and previous myocardial infarction. During the follow-up of 5 years, compared to the patients without OAC treatment, patients with OAC had a significantly lower risk of MACEs (20.60% vs. 58.95%, adjusted HR: 0.21, 95% CI: 0.15–0.30, p < 0.001) but a higher risk of BARC ≥ 3 bleeding events (4.65% vs. 1.32%, adjusted HR: 4.71, 95% CI: 1.75–12.64, p = 0.002). In combination, a lower risk of net clinical outcomes could be observed in the patients with OACs (23.26% vs. 58.96%, adjusted HR: 0.27, 95% CI: 0.19–0.38, p < 0.001). Among the patients with OAC treatment, no significant difference was found for MACEs or BARC ≥ 3 bleeding events between the patients with or without comedications of oral antiplatelet agents. Conclusions A net clinical benefit of efficacy and safety could be observed in OAC-treated elderly patients with SCAD and AF. This benefit is independent of the comedications of oral antiplatelet treatment.

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Characteristics and antithrombotic treatment patterns of patients with concomitant coronary artery disease and atrial fibrillation from Thailand’s COOL-AF registry

Cited by 2 publications

References 27 publications

Efficacy and Safety of Antithrombotic Therapy With Oral Anticoagulants in Real-World Elderly Patients With Acute Coronary Syndrome and Atrial Fibrillation

Efficacy and Safety of Antithrombotic Therapy With Oral Anticoagulants in Real-World Elderly Patients With Acute Coronary Syndrome and Atrial Fibrillation

Efficacy and safety of oral anticoagulants in elderly patients with stable coronary artery disease and atrial fibrillation

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