Key result
Triple therapy significantly reduced the rate of thromboembolism compared to dual antiplatelet therapy (0.6% vs 6.9%, HR 0.08) in elderly patients with atrial fibrillation undergoing PCI, despite a higher rate of major bleeding.
Why the study?
Does triple therapy improve thromboembolism and mortality compared to DAPT in elderly patients with atrial fibrillation undergoing PCI?
Cohort (n=289)
Yes
Does triple therapy improve thromboembolism and mortality compared to DAPT in elderly patients with atrial fibrillation undergoing PCI?
Hazard Ratio: 0.08 (95% CI 0.01–0.7)
Absolute Event Rate: 0.6% vs 6.9%
p-value: p=0.004
In elderly patients with atrial fibrillation undergoing PCI, triple therapy reduces thromboembolism and mortality but significantly increases major bleeding compared to DAPT.
May support triple therapy in elderly AF-PCI patients; leaves open need for randomized confirmation before practice change.
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.
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Sambola et al. (2016) conducted a cohort in Atrial fibrillation undergoing percutaneous coronary intervention (n=289). Triple therapy (oral anticoagulation plus aspirin plus clopidogrel) vs. Dual antiplatelet therapy (DAPT) was evaluated on Thromboembolism (stroke or systemic embolism) (HR 0.08, 95% CI 0.01-0.70, p=0.004). Triple therapy significantly reduced the rate of thromboembolism compared to dual antiplatelet therapy (0.6% vs 6.9%, HR 0.08) in elderly patients with atrial fibrillation undergoing PCI, despite a higher rate of major bleeding.
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