Title
Safe and Efficacious Use of 1-Month Triple Therapy in Patients with Atrial Fibrillation and High Bleeding Risk Undergoing PCI
Date Issued
15 August 2019
Access level
metadata only access
Resource Type
journal article
Author(s)
Sambola A.
Bueno H.
Miranda B.
Limeres J.
del Blanco B.G.
GarcÃa-Dorado D.
University of Connecticut
Publisher(s)
Springer New York LLC
Abstract
Background: The impact of short or prolonged use of triple therapy (TT) on outcomes in patients with atrial fibrillation (AF) and high risk of bleeding undergoing percutaneous coronary intervention (PCI) is unclear. We compared clinical outcomes according to the duration of TT in patients with AF and HAS-BLED ≥ 3 at 1 year of follow-up. Methods: A prospective observational cohort enrolled 735 patients with AF between 2010 and 2015. Of these, 521 (70.9%) had HAS-BLED ≥ 3 and 380 (72.9%) were discharged on TT. TT was prescribed for 1 month in 233 patients (61.3%). The primary endpoint was the incidence of Bleeding Academic Research Consortium (BARC ≥ 3). The secondary endpoint was the occurrence of ischemic events (cardiac death, MI, stroke, or stent thrombosis). Results: Patients on 1-month TT had a higher median HAS-BLED. Intracraneal hemorrhage was twofold more frequently in patients on > 1-month TT but without statistical significance (0.9% vs 2.1%, p = 0.20). Rates of the primary endpoint (bleeding BARC ≥ 3) were 8.2% vs 10.9% and did not differ between groups, while secondary endpoint did not occur more frequently in the 1-month TT group compared with the > 1-month TT group (26.6% vs 23.1%). In adjusted multivariate analyses, patients receiving 1-month TT had a similar risk of the primary endpoint compared to those with > 1-month TT (HR 1.47; 95% CI 0.48–4.47, p = 0.50). No difference was found in the secondary ischemic endpoint (HR 1.24; 95% CI 0.77–2.00, p = 0.38). Conclusions: In patients with AF undergoing PCI at lower ischemic risk and higher bleeding risk, 1 month of TT seems safe and efficacious. Further studies are warranted in patients at high ischemic risk.
Start page
425
End page
433
Volume
33
Issue
4
Language
English
OCDE Knowledge area
Sistema cardiaco, Sistema cardiovascular
FarmacologÃa, Farmacia
OncologÃa
Subjects
Scopus EID
2-s2.0-85069492209
PubMed ID
Source
Cardiovascular Drugs and Therapy
ISSN of the container
09203206
DOI of the container
10.1007/s10557-019-06889-7
Source funding
AstraZeneca
Instituto de Salud Carlos III
Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares
Sponsor(s)
This study was supported by CIBERCV. No additional external funding was received.
Dr. Sambola reports grant from Amgen to the institution, fees from lectures, Amgen, Boehringer-Ingelheim, Bristol-Myers, BMS-Pfizer, Astra-Zeneca, Novartis, Novo-nordisk outside the submitted work. Dr. Bueno reports grants from Instituto de Salud Carlos III; personal fees from Bayer; personal fees from Novartis; grants, personal fees, and non-financial support from AstraZeneca; grants and personal fees from BMS-Pfizer; personal fees from Ferrer; personal fees from MEDSCAPE-the Heart-org; and personal fees from Janssen, outside the submitted work. The remaining authors no have disclosures to declare.
Sources of information:
Directorio de Producción CientÃfica
Scopus