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2016-01-25

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cc-by (c) Sambola Ayala, Antonia et al., 2016
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/111147

Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention

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https://doi.org/10.1371/journal.pone.0147245

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Background and Purpose: Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplate- let therapy: aspirin plus clopidogrel) in patients > 75 years of age with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). Methods: A prospective multicenter study was conducted from 2003 to 2012 at 6 Spanish teaching hospitals. A cohort study of consecutive patients with AF undergoing PCI and treated with TT or dual antiplatelet therapy (DAPT) was analyzed. All outcomes were evaluated at 1- year of follow-up. Results: Five hundred and eighty-five patients, 289 (49%) of whom were > 75 years of age (79.6 ± 3.4 years; 33% women) were identified. TT was prescribed in 55.9% of patients at discharge who had a higher thromboembolic risk (CHA 2 DS 2 VASc score: 4.23 ± 1.51 vs 3.76 ± 1.40, p = 0.007 and a higher bleeding risk (HAS-BLED > 3: 88.6% vs 79.2%, p = 0.02) than those on DAPT. Therefore, patients on TT had a lower rate of thromboembolism than those on DAPT (0.6% vs 6.9%, p = 0.004; HR 0.08, 95% CI: 0.01 - 0.70, p = 0.004). Major bleeding events occurred more frequently in patients on TT than in those on DAPT (11.7% vs 2.4%, p = 0.002; HR 5.2, 95% CI: 1.53 - 17.57, p = 0.008). The overall mortality rate was similar in both treatment groups (11.9% vs 13.9%, p = 0.38); however, after adjustment for confounding variables, TT was associated with a reduced mortality rate (HR 0.33, 95% CI: 0.12 - 0.86, p = 0.02). Conclusions In elderly patients with AF undergoing PCI, the use of TT compared to DAPT was associ- ated with reduced thromboembolism and mortality rates, although a higher rate of major bleeding.

Matèries

Persones grans, Fibril·lació auricular, Malalties coronàries, Cirurgia cardiovascular, Malalties de les persones grans

Matèries (anglès)

Older people, Atrial fibrillation, Coronary diseases, Cardiovascular surgery, Older people diseases

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SAMBOLA AYALA, Antonia, MUTUBERRÍA, Maria, GARCÍA DEL BLANCO, Bruno, ALONSO, Albert, BARRABÉS, José a., BUENO, Héctor, ALFONSO, Fernando, CEQUIER FILLAT, Àngel r., ZUECO, Javier, RODRÍGUEZ-LEOR, Oriol, TORNOS, Pilar, GARCÍA DORADO, David. Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention. _PLoS One_. 2016. Vol. 11, núm. 1, pàgs. e0147245. [consulta: 8 de gener de 2026]. ISSN: 1932-6203. [Disponible a: https://hdl.handle.net/2445/111147]

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