November 11, 2005

Aspirin, Warfarin and a Thienopyridine for Acute Coronary Syndromes

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute Coronary Syndromes (n=5706). Intervention: Triple therapy (warfarin, clopidogrel, and aspirin) vs. Dual therapy (clopidogrel and aspirin). Primary outcome: Major bleeding during hospitalization (p=0.03).

Key Result

Triple therapy in ACS patients was associated with more major bleeding during hospitalization than dual therapy (2.6% vs. 0.6%, p=0.03), with no difference in adjusted 6-month mortality.

Study Design

Type

Observational (n=5,706)

Multicenter

Yes

Structured PICO

Does triple therapy (warfarin, aspirin, clopidogrel) affect mortality and bleeding compared to dual therapy (aspirin, clopidogrel) in patients with acute coronary syndrome?

Population

5,706 patients with acute coronary syndrome discharged alive from hospital, of whom 76 received triple therapy and 2,661 received dual therapy, followed for up to 6 months.

Exposure

Triple therapy (warfarin, aspirin, and clopidogrel) (n=76)

Comparator

Dual therapy (clopidogrel and aspirin) (n=2,661)

Outcome

Incidence, complications (including major bleeding), and outcomes (30-day and 6-month mortality)hard clinical

In patients with acute coronary syndrome, adding warfarin to dual antiplatelet therapy increases major bleeding risk without a significant difference in 6-month mortality.

Main Result

Absolute Event Rate: 2.6% vs 0.6%

p-value: p=0.03

Abstract

BACKGROUND: Although clopidogrel and aspirin (dual therapy, DT) are used for acute coronary syndrome (ACS), sometimes treatment with warfarin (triple therapy, TT) is required. AIM: To determine the incidence, complications, and outcomes of TT. METHODS: We analyzed Israeli surveys of ACS from 2000 to 2004. RESULTS: In these surveys, 5,706 (96%) were discharged alive from hospital. Post-ACS TT and DT were 76 patients (1.3%) and 2,661 patients (46.7%), respectively. The TT group was older with more prior cardiac disease. During hospitalization, the TT patients received more intravenous anticoagulant and antithrombotic agents, and had more heart failure, arrhythmias, ischemia, and major bleeding (2.6 vs. 0.6%, p=0.03). There were no differences in adjusted 30-day and 6-month mortality between the 2 groups. CONCLUSION: TT is feasible among ACS patients who require concomitant warfarin treatment.

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Cite This Study

Konstantino et al. (Fri,) conducted a observational in Acute Coronary Syndromes (n=5,706). Triple therapy (warfarin, clopidogrel, and aspirin) vs. Dual therapy (clopidogrel and aspirin) was evaluated on Major bleeding during hospitalization (p=0.03). Triple therapy in ACS patients was associated with more major bleeding during hospitalization than dual therapy (2.6% vs. 0.6%, p=0.03), with no difference in adjusted 6-month mortality.

synapsesocial.com/papers/6a1fde1b10c23ffe0e4306af https://doi.org/https://doi.org/10.1159/000089548

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