Optimal long-term antithrombotic treatment of patients with stable coronary artery disease and atrial fibrillation : "OLTAT registry"
Copyright © 2018 Elsevier B.V. All rights reserved..
BACKGROUND: The optimal long-term antithrombotic treatment of patients with stable coronary artery disease (CAD) and atrial fibrillation (AF) is a challenge in daily practice. We sought to determine the prevalence of hemorrhagic complications and ischaemic events depending on antithrombotic strategy in patients with stable CAD and AF.
METHODS: The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of cardiovascular mortality, myocardial infarction and ischaemic stroke. The subsequent risks of MACCE and clinically significant bleedings requiring hospitalisation (major safety outcome) were analyzed in a propensity score-matched analysis by adjusted Cox regression models.
RESULTS: Six hundred and six patients with high thrombotic and bleeding risks (mean age 73.4 ± 9.8 years, 25.2% female, CHA2DS2-VASc score:4.7 ± 1.5, and HAS-BLED score:3.1 ± 1.0) were included, and 127 propensity-matched pairs were analyzed. At inclusion, 172 patients (28.4%) were on oral anticoagulation (OAC) alone (75.6% on VKA and 24.4% on DOAC) and 434 patients (71.6%) on OAC + single antiplatelet therapy (SAPT) (71.9% on VKA and 28.1% on DOAC). At 5-year follow-up, MACCE rate did not significantly differ in both groups (30.9% in OAC + SAPT vs. 26.8% in OAC alone; adjusted HR 1.1 [0.8-1.5], p = 0.58), but clinically significant bleedings (28.3% vs. 18.5%; adjusted HR 1.8 [1.2-2.8], p = 0.005) and total deaths (29.5% vs. 20.8%; adjusted HR 1.4 [95% CI 1.0-2.2], p = 0.049) were higher in patients with OAC + SAPT than in patients with OAC alone.
CONCLUSIONS: In patients with stable CAD and AF, the addition of antiplatelet therapy to VKA or DOAC therapy was independently associated with a higher risk of bleeding and overall mortality, without significant reduction in cardiac and cerebral ischaemic events.
| Errataetall: |
CommentIn: Int J Cardiol. 2018 Aug 1;264:95-96. - PMID 29776578 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:264 |
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| Enthalten in: |
International journal of cardiology - 264(2018) vom: 01. Aug., Seite 64-69 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Fischer, Q [VerfasserIn] |
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| Links: |
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| Themen: |
Antithrombotic treatment |
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| Anmerkungen: |
Date Completed 09.01.2019 Date Revised 10.12.2019 published: Print CommentIn: Int J Cardiol. 2018 Aug 1;264:95-96. - PMID 29776578 Citation Status MEDLINE |
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| doi: |
10.1016/j.ijcard.2018.03.018 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM284227242 |
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| 245 | 1 | 0 | |a Optimal long-term antithrombotic treatment of patients with stable coronary artery disease and atrial fibrillation |b "OLTAT registry" |
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| 500 | |a Date Completed 09.01.2019 | ||
| 500 | |a Date Revised 10.12.2019 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Int J Cardiol. 2018 Aug 1;264:95-96. - PMID 29776578 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2018 Elsevier B.V. All rights reserved. | ||
| 520 | |a BACKGROUND: The optimal long-term antithrombotic treatment of patients with stable coronary artery disease (CAD) and atrial fibrillation (AF) is a challenge in daily practice. We sought to determine the prevalence of hemorrhagic complications and ischaemic events depending on antithrombotic strategy in patients with stable CAD and AF | ||
| 520 | |a METHODS: The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of cardiovascular mortality, myocardial infarction and ischaemic stroke. The subsequent risks of MACCE and clinically significant bleedings requiring hospitalisation (major safety outcome) were analyzed in a propensity score-matched analysis by adjusted Cox regression models | ||
| 520 | |a RESULTS: Six hundred and six patients with high thrombotic and bleeding risks (mean age 73.4 ± 9.8 years, 25.2% female, CHA2DS2-VASc score:4.7 ± 1.5, and HAS-BLED score:3.1 ± 1.0) were included, and 127 propensity-matched pairs were analyzed. At inclusion, 172 patients (28.4%) were on oral anticoagulation (OAC) alone (75.6% on VKA and 24.4% on DOAC) and 434 patients (71.6%) on OAC + single antiplatelet therapy (SAPT) (71.9% on VKA and 28.1% on DOAC). At 5-year follow-up, MACCE rate did not significantly differ in both groups (30.9% in OAC + SAPT vs. 26.8% in OAC alone; adjusted HR 1.1 [0.8-1.5], p = 0.58), but clinically significant bleedings (28.3% vs. 18.5%; adjusted HR 1.8 [1.2-2.8], p = 0.005) and total deaths (29.5% vs. 20.8%; adjusted HR 1.4 [95% CI 1.0-2.2], p = 0.049) were higher in patients with OAC + SAPT than in patients with OAC alone | ||
| 520 | |a CONCLUSIONS: In patients with stable CAD and AF, the addition of antiplatelet therapy to VKA or DOAC therapy was independently associated with a higher risk of bleeding and overall mortality, without significant reduction in cardiac and cerebral ischaemic events | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Antithrombotic treatment | |
| 650 | 4 | |a Atrial fibrillation | |
| 650 | 4 | |a Bleeding | |
| 650 | 4 | |a Ischaemic event | |
| 650 | 4 | |a Stable coronary artery disease | |
| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 700 | 1 | |a Georges, J L |e verfasserin |4 aut | |
| 700 | 1 | |a Le Feuvre, C |e verfasserin |4 aut | |
| 700 | 1 | |a Sharma, A |e verfasserin |4 aut | |
| 700 | 1 | |a Hammoudi, N |e verfasserin |4 aut | |
| 700 | 1 | |a Berman, E |e verfasserin |4 aut | |
| 700 | 1 | |a Cohen, S |e verfasserin |4 aut | |
| 700 | 1 | |a Jolivet, I |e verfasserin |4 aut | |
| 700 | 1 | |a Silvain, J |e verfasserin |4 aut | |
| 700 | 1 | |a Helft, G |e verfasserin |4 aut | |
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