Outcomes of anticoagulated patients with atrial fibrillation treated with or without antiplatelet therapy - A pooled analysis from the PREFER in AF and PREFER in AF PROLONGATON registries
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Outcomes of anticoagulated patients with atrial fibrillation treated with or without antiplatelet therapy - A pooled analysis from the PREFER in AF and PREFER in AF PROLONGATON registries. / Patti, Giuseppe; Pecen, Ladislav; Lucerna, Markus; Huber, Kurt; Rohla, Miklos; Renda, Giulia; Siller-Matula, Jolanta; Schnabel, Renate B; Cemin, Roberto; Kirchhof, Paulus; De Caterina, Raffaele.
in: INT J CARDIOL, Jahrgang 270, 01.11.2018, S. 160-166.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Outcomes of anticoagulated patients with atrial fibrillation treated with or without antiplatelet therapy - A pooled analysis from the PREFER in AF and PREFER in AF PROLONGATON registries
AU - Patti, Giuseppe
AU - Pecen, Ladislav
AU - Lucerna, Markus
AU - Huber, Kurt
AU - Rohla, Miklos
AU - Renda, Giulia
AU - Siller-Matula, Jolanta
AU - Schnabel, Renate B
AU - Cemin, Roberto
AU - Kirchhof, Paulus
AU - De Caterina, Raffaele
N1 - Copyright © 2018 Elsevier B.V. All rights reserved.
PY - 2018/11/1
Y1 - 2018/11/1
N2 - BACKGROUND: Evidence on whether antiPLT added to OACs is of advantage in atrial fibrillation (AF) patients with concomitant stable coronary artery disease (CAD) is limited. We evaluated clinical outcomes with oral anticoagulant (OAC) monotherapy vs antiplatelet therapy (antiPLT) plus OAC in patients with AF and stable CAD.METHODS: Data on 1058 AF patients on OACs and history (>1 year) of myocardial infarction or coronary stenting were pooled from the PREFER-in-AF and PREFER-in-AF PROLONGATION registries. We primarily compared the 1-year incidence of a net composite endpoint (primary endpoint), including acute coronary syndrome and major bleeding, with or without antiPLT.RESULTS: The incidence of the primary net composite endpoint was significantly higher in patients receiving OACs + antiPLT (N = 348) vs OACs alone (N = 710): 7.9 vs 4.2 per 100 patients/year; adjusted OR [95% CI] 1.84 [1.01-3.37]; p = 0.048. Among the components of the primary endpoint, the greatest relative difference was found for major bleeding (OR [95% CI] 2.28 [95% CI 1.00-5.19]), and especially life-threatening or non-gastrointestinal bleeding. The net clinical outcome with OACs + antiPLT was poorer irrespective of the type of CAD (previous infarction or coronary stenting), the type of stent (bare metal or drug-eluting) or the type of OAC (vitamin K antagonist or non-vitamin K antagonist OAC).CONCLUSIONS: Among patients with AF and stable CAD >1-year after the index event, the addition of antiPLT to OAC does not apparently provide added protection against coronary events, but increases major bleeding. OAC monotherapy should thus be considered the antithrombotic therapy of choice for such patients.
AB - BACKGROUND: Evidence on whether antiPLT added to OACs is of advantage in atrial fibrillation (AF) patients with concomitant stable coronary artery disease (CAD) is limited. We evaluated clinical outcomes with oral anticoagulant (OAC) monotherapy vs antiplatelet therapy (antiPLT) plus OAC in patients with AF and stable CAD.METHODS: Data on 1058 AF patients on OACs and history (>1 year) of myocardial infarction or coronary stenting were pooled from the PREFER-in-AF and PREFER-in-AF PROLONGATION registries. We primarily compared the 1-year incidence of a net composite endpoint (primary endpoint), including acute coronary syndrome and major bleeding, with or without antiPLT.RESULTS: The incidence of the primary net composite endpoint was significantly higher in patients receiving OACs + antiPLT (N = 348) vs OACs alone (N = 710): 7.9 vs 4.2 per 100 patients/year; adjusted OR [95% CI] 1.84 [1.01-3.37]; p = 0.048. Among the components of the primary endpoint, the greatest relative difference was found for major bleeding (OR [95% CI] 2.28 [95% CI 1.00-5.19]), and especially life-threatening or non-gastrointestinal bleeding. The net clinical outcome with OACs + antiPLT was poorer irrespective of the type of CAD (previous infarction or coronary stenting), the type of stent (bare metal or drug-eluting) or the type of OAC (vitamin K antagonist or non-vitamin K antagonist OAC).CONCLUSIONS: Among patients with AF and stable CAD >1-year after the index event, the addition of antiPLT to OAC does not apparently provide added protection against coronary events, but increases major bleeding. OAC monotherapy should thus be considered the antithrombotic therapy of choice for such patients.
KW - Aged
KW - Aged, 80 and over
KW - Anticoagulants/administration & dosage
KW - Atrial Fibrillation/diagnosis
KW - Female
KW - Hemorrhage/chemically induced
KW - Humans
KW - Male
KW - Observational Studies as Topic/methods
KW - Platelet Aggregation Inhibitors/administration & dosage
KW - Prospective Studies
KW - Registries
KW - Treatment Outcome
U2 - 10.1016/j.ijcard.2018.06.098
DO - 10.1016/j.ijcard.2018.06.098
M3 - SCORING: Journal article
C2 - 30220376
VL - 270
SP - 160
EP - 166
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
ER -
