Triple vs Dual Antithrombotic Therapy in Patients with Atrial Fibrillation and Coronary Artery Disease

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• 作者：Renato D. Lopes ; MD ; MHS ; PhD^a ; ^{renato.lopes@duke.edu" class="auth_mail" title="E-mail the corresponding author} ; Meena Rao ; MD^a ; DaJuanicia N. Simon ; MS^a ; Laine Thomas ; PhD^a ; Jack Ansell ; MD^b ; Gregg C. Fonarow ; MD^c ; Bernard J. Gersh ; MB ; ChB ; DPhil^d ; Alan S. Go ; MD^e ; Elaine M. Hylek ; MD ; MPH^f ; Peter Kowey ; MD^g ; Jonathan P. Piccini ; MD ; MHS^a ; Daniel E. Singer ; MD^h ; Paul Chang ; MDⁱ ; Eric D. Peterson ; MD ; MPH^a ; Kenneth W. Mahaffey ; MD^j
• 关键词：Anticoagulants ; Antiplatelets ; Atrial fibrillation ; Combined therapy ; Coronary artery disease
• 刊名：The American Journal of Medicine
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：129
• 期：6
• 页码：592-599.e1
• 全文大小：876 K

文摘

The role of triple antithrombotic therapy vs dual antithrombotic therapy in patients with both atrial fibrillation and coronary artery disease remains unclear. This study explores the differences in treatment practices and outcomes between triple antithrombotic therapy and dual antithrombotic therapy in patients with atrial fibrillation and coronary artery disease.

Methods

Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (n = 10,135), we analyzed outcomes in patients with coronary artery disease (n = 1827) according to treatment with triple antithrombotic therapy (defined as concurrent therapy with an oral anticoagulant, a thienopyridine, and aspirin) or dual antithrombotic therapy (comprising either an oral anticoagulant and one antiplatelet agent [OAC plus AA] or 2 antiplatelet drugs and no anticoagulant [DAP]).

Results

The use of triple antithrombotic therapy, OAC plus AA, and DAP at baseline was 8.5% (n = 155), 80.4% (n = 1468), and 11.2% (n = 204), respectively. Among patients treated with OAC plus AA, aspirin was the most common antiplatelet agent used (90%), followed by clopidogrel (10%) and prasugrel (0.1%). The use of triple antithrombotic therapy was not affected by patient risk of either stroke or bleeding. Patients treated with triple antithrombotic therapy at baseline were hospitalized for all causes (including cardiovascular) more often than patients on OAC plus AA (adjusted hazard ratio 1.75; 95% confidence interval, 1.35-2.26; m>Pm> <.0001) or DAP (hazard ratio 1.82; 95% confidence interval, 1.25-2.65; m>Pm> = .0018). Rates of major bleeding or a combined cardiovascular outcome were not significantly different by treatment group.

Conclusions

Choice of antithrombotic therapy in patients with atrial fibrillation and coronary artery disease was not affected by patient stroke or bleeding risks. Triple antithrombotic therapy-treated patients were more likely to be hospitalized for all causes than those on OAC plus AA or on DAP.