Outcomes Associated With Oral Anticoagulants Plus Antiplatelets in Patients With Newly Diagnosed Atrial Fibrillation

Fox, Keith A; Velentgas, Priscilla; Bassand, Jean‐Pierre; Fitzmaurice, David; Gersh, Bernard J.; Goldhaber, Samuel Z.; Goto, Shinya; Haas, Sylvia; Misselwitz, Frank; Pieper, Karen S.; Turpie, Alexander G. G.; Verheugt, Freek W.A.; Dabrowski, Elizabeth; Luo, Kaiyi; Gibbs, Liza; Kakkar, Ajay K.

doi:10.1001/jamanetworkopen.2020.0107

Cited by 24 publications

(15 citation statements)

References 47 publications

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“…In 2014, the ESC approved the discontinuation of PAI in patients with stable coronary artery disease treated with long-term anticoagulant therapy [10]. This attitude is in line with the data in the literature demonstrating that the risk of bleeding is doubled with a PAI-anticoagulant combination compared with monotherapy [44], without any decrease in cardiovascular event incidence [45]. This would also explain why PAI were less prescribed in patients with a history of bleeding in this study.…”

Section: Factors Associated With Pai Prescriptionssupporting

confidence: 80%

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Laborde

Barben

Mihai

et al. 2020

IJERPH

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Platelet aggregation inhibitors (PAI) have widely proven their efficiency for the prevention of ischemic cardiovascular events. We aimed to describe PAI prescription in an elderly multimorbid population and to determine the factors that influence their prescription, including the impact of age, comorbidities and frailty, evaluated through a comprehensive geriatric assessment. This cross-sectional study included all patients admitted to the acute geriatric department of a university hospital from November 2016 to January 2017. We included 304 consecutive hospitalized patients aged 88.7 ± 5.5 years. One third of the population was treated with PAI. A total of 133 (43.8%) patients had a history of cardiovascular disease, 77 of whom were on PAI. For 16 patients, no indication was identified. The prescription or the absence of PAI were consistent with medical history in 61.8% of patients. In the multivariate analysis, among the 187 patients with an indication for PAI, neither age (odds ratio (OR) = 1.00; 95% confidence interval (CI): [0.91–1.08], per year of age), nor comorbidities (OR = 0.97; 95% CI: [0.75–1.26], per point of Charlson comorbidity index), nor cognitive disorders (OR = 0.98; 95% CI [0.91–1.06] per point of Mini Mental State Examination), nor malnutrition (OR = 1.07; 95% CI [0.96–1.18], per g/L of albumin) were significantly associated with the therapeutic decision. PAI were less prescribed in primary prevention situations, in patients taking anticoagulants and in patients with a history of bleeding. In conclusion, a third of our older comorbid population of inpatients was taking PAI. PAI prescription was consistent with medical history for 61.8% of patients. Age, multimorbidity and frailty do not appear to have a significant influence on therapeutic decision-making. Further research is needed to confirm such a persistence of cardiovascular preventive strategies in frail older patients from other settings and to assess whether these strategies are associated with a clinical benefit in this specific population.

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Section: Factors Associated With Pai Prescriptionssupporting

confidence: 80%

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Laborde

Barben

Mihai

et al. 2020

IJERPH

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“…However, contrary to the results of this study, Ruiz et al [24] reported that the use of combination therapy in AF patients initiating NOAC treatment was uncommon, at 6.1%. And 12.5% of the patients were treated with APT in addition to OACs in the GARFIELD-AF registry [25]. This finding was explained by the baseline characteristics of the enrolled patients.…”

Section: Discussionmentioning

confidence: 98%

Bleeding risk in patients with atrial fibrillation treated with combined anti-platelet and non-vitamin K antagonist oral anticoagulant therapy

Shin¹,

Kim²,

Kim³

2022

Rev. Cardiovasc. Med.

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Background:The use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (AF) has been increasing. Accordingly, the combined use of antiplatelet agents (APT) and NOAC therapy is commonly encountered in clinical practice. The purpose of this study was to compare the clinical outcomes between combination therapy (NOAC and APT) vs. monotherapy (NOAC only) in patients with AF. Methods: We retrospectively analyzed patients who were prescribed NOACs between January 2012 and December 2016. The primary outcome was major bleeding and any bleeding events, and the secondary outcomes were stroke/systemic embolic (SE) events and major adverse cardiac events (MACE). Results: Of the 1068 participants, there were 264 (24.7%) patients in the combination therapy group. The prevalence of diabetes (p = 0.017) and history of stroke and transient ischemic attacks (p < 0.001) was higher in the combination group than in the monotherapy group. During the mean 14.6 ± 9.8 months of followup, the incidence of any bleeding was significantly higher in the combination therapy group than in the monotherapy group (p < 0.001). The rate of major bleeding, stroke/SE, and MACE between the two groups was similar. The rate of under-dosage NOAC prescriptions was higher in the combination therapy group than in the monotherapy group (p = 0.024). Conclusions: The combination therapy group had higher incidences of any bleeding events compared to the monotherapy in patients with appropriate dosing. However, there was no difference in stroke/SE, and MACE. The bleeding risk in AF patients taking the combination of NOACs and APT should be carefully evaluated.

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“…Antithrombotic Management for AF and PCI Антитромботическая терапия при ФП и ЧКВ Введение Всесторонняя защита пациента с фибрилляцией предсердий (ФП), помимо снижения риска инсульта и системных эмболий, подразумевает также замедление прогрессирования почечной дисфункции, повышение приверженности терапии, а также снижение риска коронарных событий, что является ключевым фактором улучшения прогноза больных. По данным зарубежных авторов ФП у пациентов с ишемической болезнью сердца (ИБС) встречается примерно в 25-35% случаев и ассоциирована со значительным увеличением числа сердечно-сосудистых осложнений [1][2][3][4]. Коморбидность ИБС и ФП в значительной степени обусловлена общими факторами риска обоих состояний (артериальная гипертония, ожирение, сахарный диабет и пр.).…”

Section: актуальные вопросы клинической фармакологииunclassified

Antithrombotic Management for Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Панов

2021

Racionalʹnaâ farmakoterapiâ v kardiologii

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Comprehensive protection of a patient with atrial fibrillation (AF) should not only reduce the risk of stroke and systemic embolism, but also reduce the risk coronary events and ensure high adherence to treatment. In accordance with consensus document issued by the European Heart Rhythm Association, European Society of Cardiology, European Association of Percutaneous Cardiovascular Interventions, as well as with other recent Russian Society of Cardiology Guidelines, the management of antithrombotic therapy of patients with AF undergoing percutaneous coronary intervention (PCI) requires that multiple and interconnected issues. The review article addresses questions about duration of initial triple antithrombotic therapy (TAT), selection of P2Y12 inhibitor, choice of oral anticoagulant to be combined with antiplatelet therapy, intensity of oral anticoagulation throughout combination therapy, and choice of oral anticoagulant for indefinite therapy. In general, it is recommended to refuse the routine use of TAT for most patients. Accordingly, for patients who need both anticoagulant and antiplatelet therapy, it is strongly recommended that the default strategy after recent PCI is a double antithrombotic therapy consisting of an anticoagulant and one antiplatelet, preferably from the group of P2Y12 inhibitors. When conducting combined antithrombotic therapy, preference should be given to clopidogrel compared to other, more powerful P2Y12 inhibitors and direct oral anticoagulant (DOAC) instead of vitamin K antagonists. The primary choice of DOAC in patients with AF who have undergone PCI should be carried out taking into account such factors as individual risk of stroke and bleeding, adherence to treatment, concomitant diseases, pharmacological characteristics and evidence base of a specific DOAC, taking other medications, etc. The pharmacokinetic features of rivaroxaban, which create the possibility of its single administration, the evidence base for reducing coronary risks in various variants of the course of coronary heart disease, determines the special positions of the drug for the comprehensive protection of patients with AF after PCI.

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Outcomes Associated With Oral Anticoagulants Plus Antiplatelets in Patients With Newly Diagnosed Atrial Fibrillation

Cited by 24 publications

References 47 publications

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Bleeding risk in patients with atrial fibrillation treated with combined anti-platelet and non-vitamin K antagonist oral anticoagulant therapy

Antithrombotic Management for Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

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