Risks and benefits of combining aspirin with anticoagulant therapy in patients with atrial fibrillation: An exploratory analysis of stroke prevention using an oral thrombin inhibitor in atrial fibrillation (SPORTIF) trials

Flaker, Greg C.; Gruber, Michael J.; Connolly, Stuart J.; Goldman, Steven; Chaparro, Sandra; Vahanian, Alec; Halinen, Matti; Horrow, Jay; Halperin, Jonathan L.

doi:10.1016/j.ahj.2006.06.024

Cited by 164 publications

(155 citation statements)

References 18 publications

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“…Subjects who took other combinations of medications (n 57), including 23 subjects who took various combinations of antiplatelet and anticoagulant agents, also had a relatively high number of bleeding events. These findings are consistent with the results of previous studies, which showed that the concomitant administration of antiplatelet and anticoagulant agents was associated with a relatively high risk of bleeding complications [28][29][30] . From the results of our study, however, we were unable to conclude that the combined use of antiplatelet and anticoagulant agents was an independent predictor of bleeding events.…”

Section: Discussionsupporting

confidence: 83%

Platelet Function Measured Using a Whole Blood Aggregometer Can Predict Bleeding Events

Sairaku¹,

Nakano

Eno³

et al. 2011

JAT

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Aim:We hypothesized that excessive suppression of platelet function due to antiplatelet therapy can increase the incidence of bleeding complications. The aim of the present study was to find whether we could predict bleeding events by measuring platelet function. Methods: We enrolled 743 subjects whose platelet function was measured using a whole blood aggregometer based on a screen filtration pressure method. Of these subjects, 551 (74.2%) were treated with some type of antiplatelet agent. The endpoints were bleeding or ischemic events requiring hospitalization or extension of hospital stay. We prospectively compared the platelet function of subjects with and without bleeding or ischemic events.

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Section: Discussionsupporting

confidence: 83%

Platelet Function Measured Using a Whole Blood Aggregometer Can Predict Bleeding Events

Sairaku¹,

Nakano

Eno³

et al. 2011

JAT

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“…19 AF patients with a history of stable vascular disease should be treated with warfarin only (ie, aspirin should not be added because of an excessive risk of bleeding). 17,48,49 However, when AF patients present with acute coronary syndrome and/or undergo coronary stenting, oral anticoagulationalone does not protect sufficiently against new vascular events and stent thrombosis, and concomitant treatment with antiplatelet drugs is indicated, 50,51 although combination therapy substantially increases the risk of bleeding. 52 In the consensus document from the European Society of Cardiology Working Group on Thrombosis, endorsed by the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions (which includes a systematic review of the published literature), specific antithrombotic treatment regimes were suggested according to bleeding risk, clinical setting, and type of stent (Table 2).…”

Section: Antithrombotic Therapy In Atrial Fibrillation Plus Vascular mentioning

confidence: 99%

Atrial Fibrillation and Vascular Disease—A Bad Combination

Olesen

Gislason

Torp‐Pedersen

et al. 2012

Clinical Cardiology

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This article provides an overview of (i) the risk of stroke associated with vascular disease (acute coronary syndromes and peripheral artery disease) in patients with atrial fibrillation, (ii) the frequent coexistence of vascular disease in patients with atrial fibrillation and, (iii) the cardiovascular risk associated with the coexisting of the two diseases. The literature on this topic is relatively sparse, and we discuss results from both clinical trials and observational studies.There is a clear indication of an increased stroke risk associated with vascular disease in patients with atrial fibrillation. Indeed, patients with atrial fibrillation often had coexisting vascular disease (around 18%), and the combination of the two diseases substantially increases the risk of future cardiovascular events. The increased risk associated with peripheral artery disease in atrial fibrillation is even more pronounced.Patients with atrial fibrillation and stable vascular disease should be treated with oral anticoagulation only, although when these patients present with acute coronary syndrome and/or undergo coronary stenting, concomitant treatment with antiplatelet drugs is indicated. To guide antithrombotic management in patients with atrial fibrillation, several stroke and bleeding risk prediction schemes have been developed. Clin. Cardiol. 2012 DOI: 10.1002/clc.20955Dr. Olesen received an honorarium through an educational grant from Sanofi Aventis for time and expertise spent writing this article. Dr Lip has served as a consultant for Bayer, Astellas, Merck, AstraZeneca, Sanofi, BMS/Pfizer, Biotronik, Portola and Boehringer Ingelheim and has been on the speakers bureau for Bayer, BMS/Pfizer, Boehringer Ingelheim, and Sanofi‐Aventis. Drs. Gislason and Torp‐Pedersen disclose no conflicts of interest.

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“…Добавление антиагреганта к варфарину у пациен-тов с высоким риском развития сердечно-сосудистых осложнений также не позволяет снизить риск развития инсульта или системной эмболии по сравнению с мо-нотерапией варфарином, но приводит к повышению риска кровотечения [26]. Причем клопидогрел ассо-циируется с более высоким риском геморрагических осложнений, чем АСК [27].…”

Section: Antiplatelet Therapy Of Atrial Fibrillation In the Elderlyunclassified

Antiplatelet Therapy of Atrial Fibrillation: Focus on the Elderly

Ушкалова

Zyryanov

Dumchenko

2017

Racionalʹnaâ farmakoterapiâ v kardiologii

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ВведениеИсторически антиагреганты рассматривалась в ка-честве более безопасной альтернативы антикоагулян-там у больных с фибрилляцией предсердий (ФП) с низ-ким или умеренным риском развития инсульта [1,2]. Несмотря на то, что в современных руководствах при-менение антиагрегантов не рекомендуется, в широкой медицинской практике они продолжают оставаться широко назначаемыми препаратами, особенно па-циентам с высоким риском кровотечения, включая лиц пожилого и старческого возраста [3][4][5][6][7].Эффективность и безопасность антиагрегантов у пациентов с фибрилляцией предсердий Единственным антиагрегантом, относительно хорошо изученным в рандомизированных контролируемых исследованиях (РКИ) у больных с ФП, является аце-тилсалициловая кислота (АСК). Низкие дозы АСК (≤100 мг/сут) существенно не снижали риск развития инсульта [8]. Данные об эффективности средних доз (>100 мг и ≤300 мг) более противоречивы. В боль-шинстве РКИ их применение ассоциировалось с не-большим снижением риска нефатального инсульта по сравнению с отсутствием лечения, но сопровожда-лось повышением риска серьезных внечерепных кро- Антиагреганты в терапии фибрилляции предсердий: фокус на пожилыхЕлена Андреевна Ушкалова*, Сергей Кенсаринович Зырянов, Екатерина Владимировна Думченко Российский университет дружбы народов. Россия 117198, Москва, ул. Миклухо-Маклая, 6В современных руководствах по лечению фибрилляции предсердий (ФП) в качестве препаратов выбора для профилактики инсульта ре-комендуют антикоагулянты, однако в реальной медицинской практике пожилым пациентам часто назначают антиагреганты. Обзор клинических и фармакоэпидемиологических исследований позволяет прийти к заключению, что риск, связанный с применением ацетилсалициловой кислоты (АСК) у пациентов в возрасте ≥75 лет, может превышать потенциальную пользу. Другие антиагреганты плохо изучены у больных ФП. Вопрос о назначении двойной антиагрегантной терапии (АСК+клопидогрел) может быть рассмотрен у пациентов с сопутствующими сердечно-сосудистыми заболеваниями, которые не подходят для антикоагулянтной терапии по каким-либо другим причинам, помимо рис-ка кровотечений, или у пациентов, отказывающихся принимать антикоагулянты. Комбинации антиагрегантов с варфарином или новыми пероральными антикоагулянтами не приводят к снижению риска развития инсульта по сравнению с монотерапией антикоагулянтами, но ассоциируются с более высоким риском кровотечений, поэтому не могут быть рекомендованы. Current guidelines for the management of atrial fibrillation (AF) recommend using anticoagulants as first-line drugs for stroke prevention, but in real medical practice antiplatelet drugs are often prescribed to elderly patients. Review of clinical and pharmacoepidemiological studies allows us to conclude that risk associated with acetylsalicylic acid (ASA) use in patients ≥75 years can overweigh its potential benefit. Other antiplatelet drugs are poorly studied in patients with AF. Dual antiplatelet therapy (ASA + clopidogrel) can be prescribed to elderly patients with cardiovascular comorbidity who are deemed un...

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Risks and benefits of combining aspirin with anticoagulant therapy in patients with atrial fibrillation: An exploratory analysis of stroke prevention using an oral thrombin inhibitor in atrial fibrillation (SPORTIF) trials

Cited by 164 publications

References 18 publications

Platelet Function Measured Using a Whole Blood Aggregometer Can Predict Bleeding Events

Platelet Function Measured Using a Whole Blood Aggregometer Can Predict Bleeding Events

Atrial Fibrillation and Vascular Disease—A Bad Combination

Antiplatelet Therapy of Atrial Fibrillation: Focus on the Elderly

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