Impact of Triple Therapy in Elderly Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention
Sambola, Antonia (Hospital Universitari Vall d'Hebron)
Mutuberria Urdániz, María (Hospital Universitari Vall d'Hebron)
García del Blanco, Bruno (Hospital Universitari Vall d'Hebron)
Alonso, Albert (Hospital Universitari Vall d'Hebron)
Barrabés, José A (Hospital Universitari Vall d'Hebron)
Bueno, Héctor (Hospital General Universitario Gregorio Marañón)
Alfonso, Fernando (Hospital Clínico San Carlos (Madrid))
Cequier, Ángel (Hospital Universitari de Bellvitge)
Zueco, Javier (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Rodríguez Leor, Oriol (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Tornos Mas, Pilar (Hospital Universitari Vall d'Hebron)
García-Dorado, David (Hospital Universitari Vall d'Hebron)

Data:	2016
Resum:	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 antiplatelet 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 (CHA2DS2VASc 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 associated with reduced thromboembolism and mortality rates, although a higher rate of major bleeding.
Ajuts:	Instituto de Salud Carlos III TRA-200 Instituto de Salud Carlos III EC11-473
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Cor ; Malalties ; Atrial fibrillation ; Percutaneous coronary intervention
Publicat a:	PloS one, Vol. 11 Núm. 1 (January 2016) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0147245
PMID: 26808678

12 p, 565.3 KB

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