Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention

Morten Lamberts; Gunnar H Gislason; Jonas Bjerring Olesen; Søren Lund Kristensen; Anne-Marie Schjerning Olsen; Anders Mikkelsen; Christine Benn Christensen; Gregory Y.H. Lip; Lars Køber; Christian Torp-Pedersen; Morten Lock Hansen

doi:10.1016/j.jacc.2013.05.029

Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention

Morten Lamberts, Gunnar H Gislason, Jonas Bjerring Olesen, Søren Lund Kristensen, Anne-Marie Schjerning Olsen, Anders Mikkelsen, Christine Benn Christensen, Gregory Y.H. Lip, Lars Køber, Christian Torp-Pedersen, Morten Lock Hansen

Department of Clinical Medicine

253 Citations (Scopus)

Abstract

Objectives The purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI). Background The optimal antithrombotic treatment strategy is unresolved in patients with multiple indications. Methods A total of 12,165 AF patients hospitalized with MI and/or undergoing PCI between 2001 and 2009 were identified by nationwide registries (60.7% male; mean age 75.6 years). Risk of MI/coronary death, ischemic stroke, and bleeding according to antithrombotic treatment regimen was estimated by Cox regression models. Results Within 1 year, MI or coronary death, ischemic stroke, and bleeding events occurred in 2,255 patients (18.5%), 680 (5.6%), and 769 (6.3%), respectively. Relative to triple therapy (oral anticoagulation [OAC] plus aspirin plus clopidogrel), no increased risk of recurrent coronary events was seen for OAC plus clopidogrel (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.48 to 1.00), OAC plus aspirin (HR: 0.96, 95% CI: 0.77 to 1.19), or aspirin plus clopidogrel (HR: 1.17, 95% CI: 0.96 to 1.42), but aspirin plus clopidogrel was associated with a higher risk of ischemic stroke (HR: 1.50, 95% CI: 1.03 to 2.20). Also, OAC plus aspirin and aspirin plus clopidogrel were associated with a significant increased risk of all-cause death (HR: 1.52, 95% CI: 1.17 to 1.99 and HR: 1.60, 95% CI: 1.25 to 2.05, respectively). When compared to triple therapy, bleeding risk was nonsignificantly lower for OAC plus clopidogrel (HR: 0.78, 95% CI: 0.55 to 1.12) and significantly lower for OAC plus aspirin and aspirin plus clopidogrel. Conclusions In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy.

Original language	English
Journal	Journal of the American College of Cardiology
Volume	62
Issue number	11
Pages (from-to)	981-989
Number of pages	9
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2013.05.029
Publication status	Published - 10 Sept 2013

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10.1016/j.jacc.2013.05.029

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Lamberts, M., Gislason, G. H., Olesen, J. B., Kristensen, S. L., Schjerning Olsen, A-M., Mikkelsen, A., Christensen, C. B., Lip, G. Y. H., Køber, L., Torp-Pedersen, C., & Hansen, M. L. (2013). Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention. Journal of the American College of Cardiology, 62(11), 981-989. https://doi.org/10.1016/j.jacc.2013.05.029

Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention. / Lamberts, Morten; Gislason, Gunnar H; Olesen, Jonas Bjerring et al.

In: Journal of the American College of Cardiology, Vol. 62, No. 11, 10.09.2013, p. 981-989.

Research output: Contribution to journal › Journal article › Research › peer-review

Lamberts, M, Gislason, GH, Olesen, JB, Kristensen, SL, Schjerning Olsen, A-M, Mikkelsen, A, Christensen, CB, Lip, GYH, Køber, L , Torp-Pedersen, C & Hansen, ML 2013, 'Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention', Journal of the American College of Cardiology, vol. 62, no. 11, pp. 981-989. https://doi.org/10.1016/j.jacc.2013.05.029

@article{b4bb788b1e4d4e96bd2f929fce2a90f4,

title = "Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention",

abstract = "Objectives The purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI). Background The optimal antithrombotic treatment strategy is unresolved in patients with multiple indications. Methods A total of 12,165 AF patients hospitalized with MI and/or undergoing PCI between 2001 and 2009 were identified by nationwide registries (60.7% male; mean age 75.6 years). Risk of MI/coronary death, ischemic stroke, and bleeding according to antithrombotic treatment regimen was estimated by Cox regression models. Results Within 1 year, MI or coronary death, ischemic stroke, and bleeding events occurred in 2,255 patients (18.5%), 680 (5.6%), and 769 (6.3%), respectively. Relative to triple therapy (oral anticoagulation [OAC] plus aspirin plus clopidogrel), no increased risk of recurrent coronary events was seen for OAC plus clopidogrel (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.48 to 1.00), OAC plus aspirin (HR: 0.96, 95% CI: 0.77 to 1.19), or aspirin plus clopidogrel (HR: 1.17, 95% CI: 0.96 to 1.42), but aspirin plus clopidogrel was associated with a higher risk of ischemic stroke (HR: 1.50, 95% CI: 1.03 to 2.20). Also, OAC plus aspirin and aspirin plus clopidogrel were associated with a significant increased risk of all-cause death (HR: 1.52, 95% CI: 1.17 to 1.99 and HR: 1.60, 95% CI: 1.25 to 2.05, respectively). When compared to triple therapy, bleeding risk was nonsignificantly lower for OAC plus clopidogrel (HR: 0.78, 95% CI: 0.55 to 1.12) and significantly lower for OAC plus aspirin and aspirin plus clopidogrel. Conclusions In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy.",

author = "Morten Lamberts and Gislason, {Gunnar H} and Olesen, {Jonas Bjerring} and Kristensen, {S{\o}ren Lund} and {Schjerning Olsen}, Anne-Marie and Anders Mikkelsen and Christensen, {Christine Benn} and Lip, {Gregory Y.H.} and Lars K{\o}ber and Christian Torp-Pedersen and Hansen, {Morten Lock}",

year = "2013",

month = sep,

day = "10",

doi = "10.1016/j.jacc.2013.05.029",

language = "English",

volume = "62",

pages = "981--989",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

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number = "11",

}

TY - JOUR

T1 - Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention

AU - Lamberts, Morten

AU - Gislason, Gunnar H

AU - Olesen, Jonas Bjerring

AU - Kristensen, Søren Lund

AU - Schjerning Olsen, Anne-Marie

AU - Mikkelsen, Anders

AU - Christensen, Christine Benn

AU - Lip, Gregory Y.H.

AU - Køber, Lars

AU - Torp-Pedersen, Christian

AU - Hansen, Morten Lock

PY - 2013/9/10

Y1 - 2013/9/10

N2 - Objectives The purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI). Background The optimal antithrombotic treatment strategy is unresolved in patients with multiple indications. Methods A total of 12,165 AF patients hospitalized with MI and/or undergoing PCI between 2001 and 2009 were identified by nationwide registries (60.7% male; mean age 75.6 years). Risk of MI/coronary death, ischemic stroke, and bleeding according to antithrombotic treatment regimen was estimated by Cox regression models. Results Within 1 year, MI or coronary death, ischemic stroke, and bleeding events occurred in 2,255 patients (18.5%), 680 (5.6%), and 769 (6.3%), respectively. Relative to triple therapy (oral anticoagulation [OAC] plus aspirin plus clopidogrel), no increased risk of recurrent coronary events was seen for OAC plus clopidogrel (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.48 to 1.00), OAC plus aspirin (HR: 0.96, 95% CI: 0.77 to 1.19), or aspirin plus clopidogrel (HR: 1.17, 95% CI: 0.96 to 1.42), but aspirin plus clopidogrel was associated with a higher risk of ischemic stroke (HR: 1.50, 95% CI: 1.03 to 2.20). Also, OAC plus aspirin and aspirin plus clopidogrel were associated with a significant increased risk of all-cause death (HR: 1.52, 95% CI: 1.17 to 1.99 and HR: 1.60, 95% CI: 1.25 to 2.05, respectively). When compared to triple therapy, bleeding risk was nonsignificantly lower for OAC plus clopidogrel (HR: 0.78, 95% CI: 0.55 to 1.12) and significantly lower for OAC plus aspirin and aspirin plus clopidogrel. Conclusions In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy.

AB - Objectives The purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI). Background The optimal antithrombotic treatment strategy is unresolved in patients with multiple indications. Methods A total of 12,165 AF patients hospitalized with MI and/or undergoing PCI between 2001 and 2009 were identified by nationwide registries (60.7% male; mean age 75.6 years). Risk of MI/coronary death, ischemic stroke, and bleeding according to antithrombotic treatment regimen was estimated by Cox regression models. Results Within 1 year, MI or coronary death, ischemic stroke, and bleeding events occurred in 2,255 patients (18.5%), 680 (5.6%), and 769 (6.3%), respectively. Relative to triple therapy (oral anticoagulation [OAC] plus aspirin plus clopidogrel), no increased risk of recurrent coronary events was seen for OAC plus clopidogrel (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.48 to 1.00), OAC plus aspirin (HR: 0.96, 95% CI: 0.77 to 1.19), or aspirin plus clopidogrel (HR: 1.17, 95% CI: 0.96 to 1.42), but aspirin plus clopidogrel was associated with a higher risk of ischemic stroke (HR: 1.50, 95% CI: 1.03 to 2.20). Also, OAC plus aspirin and aspirin plus clopidogrel were associated with a significant increased risk of all-cause death (HR: 1.52, 95% CI: 1.17 to 1.99 and HR: 1.60, 95% CI: 1.25 to 2.05, respectively). When compared to triple therapy, bleeding risk was nonsignificantly lower for OAC plus clopidogrel (HR: 0.78, 95% CI: 0.55 to 1.12) and significantly lower for OAC plus aspirin and aspirin plus clopidogrel. Conclusions In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy.

U2 - 10.1016/j.jacc.2013.05.029

DO - 10.1016/j.jacc.2013.05.029

M3 - Journal article

C2 - 23747760

SN - 0735-1097

VL - 62

SP - 981

EP - 989

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 11

ER -

Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention

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