Combining Oral Anticoagulants With Platelet Inhibitors in Patients With Atrial Fibrillation and Coronary Disease

Caroline Sindet-Pedersen, Morten Lamberts, Laila Staerk, Anders Nissen Bonde, Jeffrey S. Berger, Jannik Langtved Pallisgaard, Morten Lock Hansen, Christian Torp-Pedersen, Gunnar H. Gislason, Jonas Bjerring Olesen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

4 Citationer (Scopus)

Resumé

BACKGROUND The optimal treatment strategy when combining antiplatelets with oral anticoagulants in patients with atrial fibrillation (AF) and myocardial infarction (MI) or undergoing percutaneous coronary intervention (PCI) is unknown. OBJECTIVES The authors investigated the risk of bleeding, ischemic stroke, MI, and all-cause mortality associated with direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in combination with aspirin, clopidogrel, or both in patients with AF following MI and/or PCI. METHODS Danish nationwide registries were used to identify patients with AF who were admitted with a MI and/or underwent PCI, between August 2011 and June 2017, treated with OAC in combination with antiplatelet(s). Patients were followed for 12 months or until an outcome, study end, or death. Standardized absolute risks were estimated on the basis of outcome-specific Cox regression models adjusted for potential confounders. Average treatment effects were obtained as standardized absolute risk differences (ARD) in risks at 3 and 12 months using the g-formula. RESULTS Overall, 3,222 patients were included in the study population, of which 875 (27 were treated with VKA + single antiplatelet therapy (SAPT), 595 (18 were treated with DOAC + SAPT, 1,074 (33 were treated with VKA + dual antiptatetet therapy (DAPT), and 678 (22 were treated with DOAC + DAPT. At 3 months, there was a significant difference in the absolute risk of MI associated with DOAC+SAPT compared with VKA+SAPT (3-month ARD -1.53% (95% confidence interval: -3.08% to -0.11, with no significant differences found regarding bleeding, ischemic stroke, and all-cause mortality. Compared with VKA+DAPT, DOAC+DAPT was associated with a significantly reduced risk of bleeding (3-month ARD -1.96 95% confidence interval: 3.46% to .0.88, with no significant difference in the absolute risk of all-cause mortality, stroke, or MI. CONCLUSIONS In a real-world population of AF patients with MI and/or after PCI, the authors found that DOAC in combination with DAPT was associated with a significantly decreased risk of bleeding and similar thromboembolic protection compared with VKA in combination with DAPT. (C) 2018 by the American College of Cardiology Foundation.
OriginalsprogEngelsk
TidsskriftJournal of the American College of Cardiology
Vol/bind72
Udgave nummer15
Sider (fra-til)1790-1800
Antal sider11
ISSN0735-1097
DOI
StatusUdgivet - 9 okt. 2018

Citer dette

Sindet-Pedersen, C., Lamberts, M., Staerk, L., Bonde, A. N., Berger, J. S., Pallisgaard, J. L., ... Olesen, J. B. (2018). Combining Oral Anticoagulants With Platelet Inhibitors in Patients With Atrial Fibrillation and Coronary Disease. Journal of the American College of Cardiology, 72(15), 1790-1800. https://doi.org/10.1016/j.jacc.2018.07.054
Sindet-Pedersen, Caroline ; Lamberts, Morten ; Staerk, Laila ; Bonde, Anders Nissen ; Berger, Jeffrey S. ; Pallisgaard, Jannik Langtved ; Hansen, Morten Lock ; Torp-Pedersen, Christian ; Gislason, Gunnar H. ; Olesen, Jonas Bjerring. / Combining Oral Anticoagulants With Platelet Inhibitors in Patients With Atrial Fibrillation and Coronary Disease. I: Journal of the American College of Cardiology. 2018 ; Bind 72, Nr. 15. s. 1790-1800.
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title = "Combining Oral Anticoagulants With Platelet Inhibitors in Patients With Atrial Fibrillation and Coronary Disease",
abstract = "BACKGROUND The optimal treatment strategy when combining antiplatelets with oral anticoagulants in patients with atrial fibrillation (AF) and myocardial infarction (MI) or undergoing percutaneous coronary intervention (PCI) is unknown. OBJECTIVES The authors investigated the risk of bleeding, ischemic stroke, MI, and all-cause mortality associated with direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in combination with aspirin, clopidogrel, or both in patients with AF following MI and/or PCI. METHODS Danish nationwide registries were used to identify patients with AF who were admitted with a MI and/or underwent PCI, between August 2011 and June 2017, treated with OAC in combination with antiplatelet(s). Patients were followed for 12 months or until an outcome, study end, or death. Standardized absolute risks were estimated on the basis of outcome-specific Cox regression models adjusted for potential confounders. Average treatment effects were obtained as standardized absolute risk differences (ARD) in risks at 3 and 12 months using the g-formula. RESULTS Overall, 3,222 patients were included in the study population, of which 875 (27 were treated with VKA + single antiplatelet therapy (SAPT), 595 (18 were treated with DOAC + SAPT, 1,074 (33 were treated with VKA + dual antiptatetet therapy (DAPT), and 678 (22 were treated with DOAC + DAPT. At 3 months, there was a significant difference in the absolute risk of MI associated with DOAC+SAPT compared with VKA+SAPT (3-month ARD -1.53{\%} (95{\%} confidence interval: -3.08{\%} to -0.11, with no significant differences found regarding bleeding, ischemic stroke, and all-cause mortality. Compared with VKA+DAPT, DOAC+DAPT was associated with a significantly reduced risk of bleeding (3-month ARD -1.96 95{\%} confidence interval: 3.46{\%} to .0.88, with no significant difference in the absolute risk of all-cause mortality, stroke, or MI. CONCLUSIONS In a real-world population of AF patients with MI and/or after PCI, the authors found that DOAC in combination with DAPT was associated with a significantly decreased risk of bleeding and similar thromboembolic protection compared with VKA in combination with DAPT. (C) 2018 by the American College of Cardiology Foundation.",
author = "Caroline Sindet-Pedersen and Morten Lamberts and Laila Staerk and Bonde, {Anders Nissen} and Berger, {Jeffrey S.} and Pallisgaard, {Jannik Langtved} and Hansen, {Morten Lock} and Christian Torp-Pedersen and Gislason, {Gunnar H.} and Olesen, {Jonas Bjerring}",
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doi = "10.1016/j.jacc.2018.07.054",
language = "English",
volume = "72",
pages = "1790--1800",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
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Sindet-Pedersen, C, Lamberts, M, Staerk, L, Bonde, AN, Berger, JS, Pallisgaard, JL, Hansen, ML, Torp-Pedersen, C, Gislason, GH & Olesen, JB 2018, 'Combining Oral Anticoagulants With Platelet Inhibitors in Patients With Atrial Fibrillation and Coronary Disease' Journal of the American College of Cardiology, bind 72, nr. 15, s. 1790-1800. https://doi.org/10.1016/j.jacc.2018.07.054

Combining Oral Anticoagulants With Platelet Inhibitors in Patients With Atrial Fibrillation and Coronary Disease. / Sindet-Pedersen, Caroline; Lamberts, Morten; Staerk, Laila; Bonde, Anders Nissen; Berger, Jeffrey S.; Pallisgaard, Jannik Langtved; Hansen, Morten Lock; Torp-Pedersen, Christian; Gislason, Gunnar H.; Olesen, Jonas Bjerring.

I: Journal of the American College of Cardiology, Bind 72, Nr. 15, 09.10.2018, s. 1790-1800.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Combining Oral Anticoagulants With Platelet Inhibitors in Patients With Atrial Fibrillation and Coronary Disease

AU - Sindet-Pedersen, Caroline

AU - Lamberts, Morten

AU - Staerk, Laila

AU - Bonde, Anders Nissen

AU - Berger, Jeffrey S.

AU - Pallisgaard, Jannik Langtved

AU - Hansen, Morten Lock

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar H.

AU - Olesen, Jonas Bjerring

PY - 2018/10/9

Y1 - 2018/10/9

N2 - BACKGROUND The optimal treatment strategy when combining antiplatelets with oral anticoagulants in patients with atrial fibrillation (AF) and myocardial infarction (MI) or undergoing percutaneous coronary intervention (PCI) is unknown. OBJECTIVES The authors investigated the risk of bleeding, ischemic stroke, MI, and all-cause mortality associated with direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in combination with aspirin, clopidogrel, or both in patients with AF following MI and/or PCI. METHODS Danish nationwide registries were used to identify patients with AF who were admitted with a MI and/or underwent PCI, between August 2011 and June 2017, treated with OAC in combination with antiplatelet(s). Patients were followed for 12 months or until an outcome, study end, or death. Standardized absolute risks were estimated on the basis of outcome-specific Cox regression models adjusted for potential confounders. Average treatment effects were obtained as standardized absolute risk differences (ARD) in risks at 3 and 12 months using the g-formula. RESULTS Overall, 3,222 patients were included in the study population, of which 875 (27 were treated with VKA + single antiplatelet therapy (SAPT), 595 (18 were treated with DOAC + SAPT, 1,074 (33 were treated with VKA + dual antiptatetet therapy (DAPT), and 678 (22 were treated with DOAC + DAPT. At 3 months, there was a significant difference in the absolute risk of MI associated with DOAC+SAPT compared with VKA+SAPT (3-month ARD -1.53% (95% confidence interval: -3.08% to -0.11, with no significant differences found regarding bleeding, ischemic stroke, and all-cause mortality. Compared with VKA+DAPT, DOAC+DAPT was associated with a significantly reduced risk of bleeding (3-month ARD -1.96 95% confidence interval: 3.46% to .0.88, with no significant difference in the absolute risk of all-cause mortality, stroke, or MI. CONCLUSIONS In a real-world population of AF patients with MI and/or after PCI, the authors found that DOAC in combination with DAPT was associated with a significantly decreased risk of bleeding and similar thromboembolic protection compared with VKA in combination with DAPT. (C) 2018 by the American College of Cardiology Foundation.

AB - BACKGROUND The optimal treatment strategy when combining antiplatelets with oral anticoagulants in patients with atrial fibrillation (AF) and myocardial infarction (MI) or undergoing percutaneous coronary intervention (PCI) is unknown. OBJECTIVES The authors investigated the risk of bleeding, ischemic stroke, MI, and all-cause mortality associated with direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in combination with aspirin, clopidogrel, or both in patients with AF following MI and/or PCI. METHODS Danish nationwide registries were used to identify patients with AF who were admitted with a MI and/or underwent PCI, between August 2011 and June 2017, treated with OAC in combination with antiplatelet(s). Patients were followed for 12 months or until an outcome, study end, or death. Standardized absolute risks were estimated on the basis of outcome-specific Cox regression models adjusted for potential confounders. Average treatment effects were obtained as standardized absolute risk differences (ARD) in risks at 3 and 12 months using the g-formula. RESULTS Overall, 3,222 patients were included in the study population, of which 875 (27 were treated with VKA + single antiplatelet therapy (SAPT), 595 (18 were treated with DOAC + SAPT, 1,074 (33 were treated with VKA + dual antiptatetet therapy (DAPT), and 678 (22 were treated with DOAC + DAPT. At 3 months, there was a significant difference in the absolute risk of MI associated with DOAC+SAPT compared with VKA+SAPT (3-month ARD -1.53% (95% confidence interval: -3.08% to -0.11, with no significant differences found regarding bleeding, ischemic stroke, and all-cause mortality. Compared with VKA+DAPT, DOAC+DAPT was associated with a significantly reduced risk of bleeding (3-month ARD -1.96 95% confidence interval: 3.46% to .0.88, with no significant difference in the absolute risk of all-cause mortality, stroke, or MI. CONCLUSIONS In a real-world population of AF patients with MI and/or after PCI, the authors found that DOAC in combination with DAPT was associated with a significantly decreased risk of bleeding and similar thromboembolic protection compared with VKA in combination with DAPT. (C) 2018 by the American College of Cardiology Foundation.

U2 - 10.1016/j.jacc.2018.07.054

DO - 10.1016/j.jacc.2018.07.054

M3 - Journal article

VL - 72

SP - 1790

EP - 1800

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 15

ER -