scholarly journals Antithrombotic treatments for patients with atrial fibrillation and a requirement for a coronary artery stent

2015 ◽  
Vol 1 (1) ◽  
pp. 5 ◽  
Author(s):  
Andrew Owen
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Triple Therapy ◽  
Antiplatelet Therapy ◽  
Stent Thrombosis ◽  
Dual Antiplatelet Therapy ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Coronary Artery Stent ◽  
Aspirin 325Mg

<p><span>Background: </span>Patients with atrial fibrillation and a coronary artery stent require anticoagulation to provide prophylaxis</p><p>against stroke and dual antiplatelet therapy to provide prophylaxis against stent thrombosis (triple therapy).</p><p>This combination increases the risk of major bleeding complications compared to either treatment alone. It is</p><p>suggested that an alternative to triple therapy is high dose dual antiplatelet therapy (aspirin 325mg/day and</p><p>clopidogrel 75 mg/day), which would have similar efficacy to triple therapy in relation to prophylaxis against</p><p>both stroke and stent thrombosis with a lower risk of bleeding complications.</p><p><span>Summary: </span>1. Patients with atrial fibrillation and a coronary artery stent require triple therapy, which is associated with</p><p>increased bleeding risk.</p><p>2. In everyday practice 50% of patients do not receive this, because of the excess bleeding risk.</p><p>3. It is suggested that for patients at increased bleeding risk and for whom it is felt that triple therapy is not</p><p>suitable, Aspirin (325mg daily) and clopidogrel (75mg daily) should be considered.</p><p> </p>

Abstract 14808: Bleed Outcomes Following Coronary Artery Stent: Risk Associated With Combined Antithrombotic Therapy Common in Atrial Fibrillation: Insights From Medicare Claims Data

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Gregory A Dadekian ◽  
Jeremy Smith ◽  
Aaron V Kaplan ◽  
Nancy E Morden
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Cox Regression ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
National Sample ◽  
Individual Characteristics ◽  
Coronary Artery Stent ◽  
Estimated Risk ◽  
Medicare Claims Data

Background: Platelet inhibitor (PI) use following coronary artery stent confers bleed risks, especially for atrial fibrillation (AF) patients on oral anticoagulants (OAC), a subgroup often excluded from randomized stent trials. We studied a national sample of elderly stent recipients to quantify bleed risks associated with combined OAC and PI, pharmacotherapy common in AF. Methods: Using a 40% Medicare random sample denominator file and associated inpatient, outpatient (2003-2012) and prescription (2006-2012) claims, we studied patients age 65 and older receiving a coronary artery stent. We measured OAC and/or prescription PI use after stent placement. Cox regression models estimated risk of bleed events adjusting for individual characteristics, morbidities, and time-varying medication use. Results Overall, 165,718 patients in our sample received a stent, 2006-2012; 20.4% had AF; mean age was 73.8 (SD 6.3). In the first month post-stent, among AF patients, 40.7% received OAC, 85.6% prescription PI, 35.9% both; among non-AF patients corresponding use was 3.5%, 90.3% and 3.1% respectively. At 13 months post stent, 61.0% of AF patients and 71.1% of non-AF patients continued using prescription PIs while 15.5% and 1.7% respectively remained on both PI and OAC therapy. Compared to those taking only prescription PIs, the risk of bleeding associated with warfarin plus PI was 2.05 (95% CI: 1.97 - 2.13); the risk associated with novel OACs (dabigatran or rivaroxaban) plus PIs was 2.60 (95% CI: 2.26 - 2.99). Conclusions: In a national, older population combined OAC and PI use following stent is common in AF patients and associated with bleeding risk. These findings should inform stent selection and antithrombotic strategies. The association between novel OACs and bleeding was unexpected and warrants further exploration as these products gain use.

Abstract 2356: Dual Antiplatelet Therapy following Percutaneous Coronary Intervention with Stent Implantation in Patients on Chronic Oral Anticoagulation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Renata Rogacka ◽  
Alaide Chieffo ◽  
Iassen Michev ◽  
Flavio Airoldi ◽  
Azeem Latib ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Triple Therapy ◽  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Stent Implantation ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Percutaneous Coronary

Objectives: To evaluate the safety of dual antiplatelet therapy in patients in whom long-term anticoagulation (AC) with warfarin is recommended. Background: It is well established that antiplatelet therapy with aspirin ad thienopiridines is required following percutaneous coronary intervention (PCI) with stent implantation. Some patients have also indication for long-term AC. The optimal antithrombotic strategy following PCI in such patients is unclear. Methods: All consecutive patients who underwent PCI with stent implantation discharged on triple therapy (defined as the combination of aspirin and thienopyridines and AC with warfarin) were analyzed. Results One-hundred and twenty-seven patients with 224 lesions: 86.6% males, mean age 69.9±8.8 years were included in the study. Drug-eluting stents (DES) were positioned in 71 (55.9%) and bare metal stent (BMS) in 53 (41.7%) patients. Atrial fibrillation (AF) was the main indication (59.1%) for AC treatment, followed by prosthetic valves (12.4%) and mural left ventricular (LV) thrombus (9.1%). Average risk of thromboembolic events in the subgroup with AF was 1.79 ± 1.23 according to CHADS2 score. The mean triple therapy duration was 5.6±4.6 and clinical follow-up 21.0±19.8 months. During the triple therapy period, 6 patients (4.7%) developed major bleeding complications; 67% of which occurred within the first month. No significant differences between DES and BMS were observed in the incidence of major (respectively 5.6% vs. 3.8%, p=1.0) and minor bleeding (respectively 1.4% vs. 3.8%, p=0.57) and mortality (respectively 5.6% vs. 1.9%, p=0.39). Four patients died in DES group: 3 of major bleeding complications and one of ischemic stroke. The only death in the BMS group was due to subarachnoid hemorrhage. A significant difference was observed in favor of DES in target vessel revascularization (14.1% vs. 28.3%, p=0.041). Conclusions: While on triple therapy, major bleeding complications occurred in 4.7% of patients, half of them were lethal and most (67%) occurred within the first month.

scholarly journals Ticagrelor: A safe option as part of triple therapy?

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mohammad Umar Farooq
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Triple Therapy ◽  
Dual Antiplatelet Therapy ◽  
Antiplatelet Agent ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Ischemic Events

Patients with atrial fibrillation who have concurrent coronary artery disease requiring percutaneous coronary intervention are subsequently prescribed dual antiplatelet therapy and anticoagulation resulting in triple therapy (TT). Ticagrelor, a reversibly binding P2Y12 antiplatelet agent, has shown superiority to clopidogrel in prevention of ischemic events and death, but is also associated with a small increase in the incidence of intracranial bleeding. This bleeding risk may be enhanced in the setting of TT. The objective of this report is to describe a case of a 70-year-old male prescribed TT with ticagrelor and to review the current literature on the safety of ticagrelor as a part of TT.

scholarly journals Dual Antiplatelet Therapy in Coronary Artery Disease: Comparison Between ACC/AHA 2016 and ESC 2017 Guidelines

2020 ◽  
Vol 15 ◽  
Author(s):  
Christopher N Floyd
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Heart Association ◽  
Bleeding Complications ◽  
Duration Of Treatment ◽  
Artery Disease ◽  
Optimal Approach ◽  
European Society Of Cardiology

Dual antiplatelet therapy (DAPT) is integral to the management of coronary artery disease (CAD) but there remains uncertainty as to the optimal approach for balancing an individual’s risk of atherothrombotic events versus their risk of bleeding complications. A myriad of clinical trials have investigated how factors such as antiplatelet selection or duration of treatment can affect outcomes in both stable CAD and acute coronary syndromes. To aid clinicians in the challenge of applying trial findings to the circumstances of individual patients, the American College of Cardiology/American Heart Association and European Society of Cardiology have released focused updates on prescribing DAPT in CAD. While the two guidelines agree on many issues, there are some differences in the recommendations. This article highlights those differences and provides comment on their aetiology.

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