Increased major bleeding complications related to triple antithrombotic therapy usage in patients with atrial fibrillation undergoing percutaneous coronary artery stenting

被引:118
作者
Manzano-Fernandez, Sergio [2 ]
Pastro, Francisco J. [2 ]
Marin, Francisco [2 ]
Cambronero, Francisco [2 ]
Caro, Cesar [2 ]
Pascual-Figal, Domingo A. [2 ]
Garrido, Iris P. [2 ]
Pinar, Eduardo [2 ]
Valdes, Mariano [2 ]
Lip, Gregory Y. H. [1 ]
机构
[1] Univ Dept Med, City Hosp, Birmingham B18 7QH, W Midlands, England
[2] Univ Hosp Virgen de la Arrixaca, Dept Cardiol, Murcia, Spain
关键词
acute coronary syndrome; anticoagulation; antiplatelet; atrial fibrillation; percutaneous coronary intervention;
D O I
10.1378/chest.08-0350
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: The optimal antithrombotic therapy strategy for atrial fibrillation (AF) patients who undergo percutaneous coronary intervention with stent implantation (PCI-S) is unknown. We assessed the safety of antithrombotic therapy strategies in AF patients with indication for oral anticoagulation (OAC) undergoing PCI-S. Methods: We studied consecutive AF patients with indication for OAC who underwent PCI-S. Nile compared patients that received triple antithrombotic therapy (TT) [aspirin, clopidogrel, and coumadin] against other regimes (non-TT) after PCI-S. The primary end point was defined as the occurrence of major bleeding complications that were termed as early major bleeding (EMB) [<= 48 h] or late major bleeding (LMB) [> 48 h]. Clinical follow-up was performed, and complications were recorded. Results: We studied 104 patients (mean age +/- SD, 72 +/- 8 years; 70% men); TT was used in 51 patients (49%). TT was associated with a higher incidence of LMB (21.6% vs non-TT, 3.8%; p = 0.006) but not of EMB (5.8% vs non-TT, 11.3%; p = 0.33). In multivariate analyses, glycoprotein (GP) IIb/IIIa inhibitor use (hazard ratio [HR], 13.5; 95% confidence interval [CI], 1.7 to 108.3, p = 0.014) and PCI-S of three vessels or left main artery disease (HR, 7.9; 95% CI, 1.6 to 39.2; p = 0.01) were independent predictors for EMB. TT use (HR, 7.1; 95% CI, 1.5 to 32.4; p = 0.012), the occurrence of EMB (HR, 6.7; 95% CI, 1.8 to 25.3; p = 0.005), and baseline anemia (HR, 3.8; 95% CI, 1.2 to 12.5; p = 0.027) were independent predictors for LMB. No differences in major cardiovascular events were observed in patients treated with Tr vs non-TT (25.5% vs 21.0%; 13 = 0.53). Conclusion: A high rate of major bleeding is observed in AF patients with indication for OAC undergoing PCI-S who receive TT. GP IIb/IIIa inhibitor use and multivessel/left main artery disease during PCI-S were independent predictors for EMB, while TT use, occurrence of EMB, and baseline anemia were independent predictors for LMB.
引用
收藏
页码:559 / 567
页数:9
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