Safe and Efficacious Use of 1-Month Triple Therapy in Patients with Atrial Fibrillation and High Bleeding Risk Undergoing PCI

Antonia Sambola, Héctor Bueno, Berta Miranda, Adrian V. Hernandez, Javier Limeres, Bruno García del Blanco, David García-Dorado

Resultado de la investigación: Contribución a una revistaArtículoInvestigaciónrevisión exhaustiva

Resumen

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.

Idioma originalInglés
Páginas (desde-hasta)425-433
Número de páginas9
PublicaciónCardiovascular Drugs and Therapy
Volumen33
N.º4
DOI
EstadoPublicada - 15 ago 2019

Huella dactilar

Percutaneous Coronary Intervention
Atrial Fibrillation
Hemorrhage
Therapeutics
Group Psychotherapy
Stents
Thrombosis
Multivariate Analysis
Stroke
Incidence
Research

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Sambola, Antonia ; Bueno, Héctor ; Miranda, Berta ; Hernandez, Adrian V. ; Limeres, Javier ; del Blanco, Bruno García ; García-Dorado, David. / Safe and Efficacious Use of 1-Month Triple Therapy in Patients with Atrial Fibrillation and High Bleeding Risk Undergoing PCI. En: Cardiovascular Drugs and Therapy. 2019 ; Vol. 33, N.º 4. pp. 425-433.
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title = "Safe and Efficacious Use of 1-Month Triple Therapy in Patients with Atrial Fibrillation and High Bleeding Risk Undergoing PCI",
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.",
keywords = "Anticoagulation, Atrial fibrillation, Bleeding, Percutaneous coronary intervention",
author = "Antonia Sambola and H{\'e}ctor Bueno and Berta Miranda and Hernandez, {Adrian V.} and Javier Limeres and {del Blanco}, {Bruno Garc{\'i}a} and David Garc{\'i}a-Dorado",
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Safe and Efficacious Use of 1-Month Triple Therapy in Patients with Atrial Fibrillation and High Bleeding Risk Undergoing PCI. / Sambola, Antonia; Bueno, Héctor; Miranda, Berta; Hernandez, Adrian V.; Limeres, Javier; del Blanco, Bruno García; García-Dorado, David.

En: Cardiovascular Drugs and Therapy, Vol. 33, N.º 4, 15.08.2019, p. 425-433.

Resultado de la investigación: Contribución a una revistaArtículoInvestigaciónrevisión exhaustiva

TY - JOUR

T1 - Safe and Efficacious Use of 1-Month Triple Therapy in Patients with Atrial Fibrillation and High Bleeding Risk Undergoing PCI

AU - Sambola, Antonia

AU - Bueno, Héctor

AU - Miranda, Berta

AU - Hernandez, Adrian V.

AU - Limeres, Javier

AU - del Blanco, Bruno García

AU - García-Dorado, David

PY - 2019/8/15

Y1 - 2019/8/15

N2 - 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.

AB - 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.

KW - Anticoagulation

KW - Atrial fibrillation

KW - Bleeding

KW - Percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85069492209&partnerID=8YFLogxK

UR - http://www.mendeley.com/research/safe-efficacious-1month-triple-therapy-patients-atrial-fibrillation-high-bleeding-risk-undergoing-pc

U2 - 10.1007/s10557-019-06889-7

DO - 10.1007/s10557-019-06889-7

M3 - Artículo

VL - 33

SP - 425

EP - 433

JO - Cardiovascular Drugs and Therapy

JF - Cardiovascular Drugs and Therapy

SN - 0920-3206

IS - 4

ER -