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Title: Effects of triple therapy in patients with non-valvular atrial fibrillation undergoing percutaneous coronary intervention regarding thromboembolic risk stratification
Author: Sambola Ayala, Antonia
Mutuberría, Maria
García del Blanco, Bruno
Alonso, Albert
Barrabés, José A.
Alfonso, Fernando
Bueno, Héctor
Cequier Fillat, Àngel R.
Zueco, Javier
Rodríguez-Leor, Oriol
Bosch, Eduard
Tornos, Pilar
García Dorado, David
Keywords: Anticoagulants (Medicina)
Fibril·lació auricular
Efectes secundaris dels medicaments
Pròtesis valvulars cardíaques
Malalties coronàries
Anticoagulants (Medicine)
Atrial fibrillation
Drug side effects
Heart valve prosthesis
Coronary diseases
Issue Date: 25-Dec-2015
Publisher: Japanese Circulation Society
Abstract: Background: the effects of dual antiplatelet therapy (DAPT) and triple therapy (TT: DAPT plus oral anticoagulation) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) regarding to CHA2DS2-VASc score remain undefined.We compare the effect of TT vs. DAPT in this setting regarding the CHA2DS2-VASc score. Methods and results: in a prospective multicenter registry, 585 patients (75.2% male, 73.2 ± 8.2 years) with AF undergoing PCI were followed up during 1 year. Of them, 157 (26.8%) had a CHA2DS2-VASc=1, and 428 (73.2%) had a CHA2DS2-VASc ≥2. TT was prescribed in 51.6% with CHA2DS2-VASc=1 and in 55.5% with CHA2DS2-VASc ≥ 2. Patients with CHA2DS2-VASc=1 receiving TT had a similar thromboembolism rate to those on DAPT (1.2% vs. 1.3%, P=0.73), but more total (19.5% vs. 6.9%, P=0.01) and a tendency to more major (4.9% vs. 0%, P=0.06) bleeding. However, patients with CHA2DS2-VASc ≥ 2 receiving TT had a lower thromboembolism rate (1.7% vs. 5.3%, P=0.03) and a trend towards more bleeds (21.8% vs. 15.6%, P=0.06), with an excess of major bleeding (8.4% vs. 3.1%, P=0.01). Rates of major adverse cardiac events (MACE) in both CHA2DS2-VASc subgroups were similar, irrespective of treatment. In a Cox multivariate analysis, TT was associated to major bleeding, but not with MACE. Conclusions: in patients with AF and CHA2DS2-VASc=1 undergoing PCI, the use of TT involves a high risk of bleeding without a significant benefit in preventing thromboembolism.
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It is part of: Circulation Journal, 2015, vol. 80, num. 2, p. 354-362
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ISSN: 1346-9843
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)

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