Effect of concomitant antiplatelet therapy on ischemic and hemorrhagic events in patients taking oral anticoagulants for nonvalvular atrial fibrillation in daily clinical practice
Effect of concomitant antiplatelet therapy on ischemic and hemorrhagic events in patients taking oral anticoagulants for nonvalvular atrial fibrillation in daily clinical practice
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DOI：
10.1002/pds.5228
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发表时间：
2021-05-03
影响因子：
2.6
通讯作者：
Ueda, Shinichiro
中科院分区：
文献类型：
--
作者：
Morimoto, Takeshi;Uchida, Kazutaka;Ueda, Shinichiro
目的：非瓣膜性房颤（NVAF）合并动脉粥样硬化性疾病患者口服抗凝剂（OACs）的抗血小板治疗（APT）具有挑战性。我们仔细审查了最近随机临床试验的普遍性，这些试验表明，在非瓣膜性房颤和冠心病（CAD）患者中，单独使用OAC优于OAC加抗血小板治疗。方法在日本71个中心进行历史多中心登记。纳入标准为采用oac诊断非瓣膜性房颤。排除标准为机械心脏瓣膜或有肺血栓或深静脉血栓病史。连续患者（N = 7826）于2013年2月登记，随访至2017年2月。共同主要终点是缺血事件和大出血。次要终点是缺血性卒中、出血性卒中和全因死亡率。结果患者平均年龄73岁；67%为男性。25%的患者服用抗血小板药物，27%的患者有CAD病史。4年累计缺血性事件和大出血发生率，APT组分别为5.9%和9.6%，No-APT组分别为5.3%和7.0%。APT组缺血性事件和大出血的校正风险比（hr）（95%可信区间[ci]）分别为1.12（0.84-1.49）和1.26（1.01-1.57）。缺血性卒中、出血性卒中和全因死亡率的校正hr （95% ci）分别为1.16（0.86-1.57）、1.31（0.70-2.48）和1.02（0.82-1.26）。结论：服用oac治疗非瓣膜性房颤患者的APT不能预防缺血性事件，但会显著增加实际情况下的大出血。
Purpose Antiplatelet therapy (APT) is challenging in patients taking oral anticoagulants (OACs) for nonvalvular atrial fibrillation (NVAF) with concomitant atherosclerotic diseases. We scrutinized the generalizability of recent randomized clinical trials showing OAC use alone was superior to OAC plus antiplatelet use in patients with NVAF and coronary artery diseases (CAD).Methods We conducted a historical multicenter registry at 71 centers in Japan. The inclusion criterion was taking OACs for NVAF. The exclusion criteria were mechanical heart valves or history of pulmonary thrombosis or deep vein thrombosis. Consecutive patients (N = 7826) were registered in February 2013 and were followed until February 2017. The co-primary endpoints were ischemic events and major bleedings. Secondary endpoints were ischemic stroke, hemorrhagic stroke, and all-cause mortality.Results The mean patient age was 73 years; 67% were men. Antiplatelets were administered in 25% of patients and 27% had history of CAD. Cumulative incidences of ischemic events and major bleedings at 4 years were 5.9% and 9.6% in the APT group and 5.3% and 7.0% in the No-APT group, respectively. The adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) of the APT group for ischemic events and major bleedings were 1.12 (0.84-1.49) and 1.26 (1.01-1.57), respectively. The adjusted HRs (95% CIs) for ischemic stroke, hemorrhagic stroke, and all-cause mortality were 1.16 (0.86-1.57), and 1.31 (0.70-2.48), and 1.02 (0.82-1.26), respectively.Conclusions APT in patients taking OACs for NVAF did not prevent ischemic events but significantly increased major bleedings in the real-world setting.