Prevalence of bleeding in patients on single or dual antiplatelet therapy combined with vitamin K antagonists or direct oral anticoagulants

Nasser Alkhushaym; Maha Aldhafeeri; Bander Almutairi; Maha A. Alenizi; Abdulkhaliq J. Alsalman

doi:10.1177/09246479241311428

January 4, 2025International Journal of Risk & Safety in Medicine

Prevalence of bleeding in patients on single or dual antiplatelet therapy combined with vitamin K antagonists or direct oral anticoagulants

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Why the study?

Anticoagulants in patients with atrial fibrillation can cause serious bleeding, particularly when combined with antiplatelet therapy, prompting an evaluation of major bleeding prevalence across dual versus triple regimens.

What is the prevalence of major bleeding in patients receiving oral anticoagulants combined with single or dual antiplatelet therapy?

Structured PICO

What is the prevalence of major bleeding in patients receiving oral anticoagulants combined with single or dual antiplatelet therapy?

P

Population

539 patients receiving oral anticoagulants, of which 202 were using oral anticoagulants in combination with either single or dual antiplatelet therapy

I

Intervention

Oral anticoagulants combined with single or dual antiplatelet therapy (aspirin, clopidogrel, or both)

C

Comparator

Different combinations of antithrombotic therapy (triple therapy vs. oral anticoagulant plus clopidogrel vs. oral anticoagulant plus aspirin)

O

Outcome

Prevalence of major bleedingsafety

Triple antithrombotic therapy and oral anticoagulants plus aspirin are associated with higher major bleeding rates compared to oral anticoagulants plus clopidogrel alone.

Implication

High bleeding with triple therapy warrants caution now; leaves open whether anticoagulant-clopidogrel dual therapy is safer.

Abstract

BackgroundPatients with atrial fibrillation often require anticoagulation therapy to prevent stroke and thromboembolism. However, anticoagulants can have serious side effects, such as bleeding, particularly when combined with antiplatelet therapy.ObjectiveThe aim of this study is to estimate the prevalence of major bleeding in patients receiving either dual or triple antithrombotic therapy.MethodThis study is a single-center retrospective chart review utilizing the hospital electronic health record. The prevalence and percentage of bleeding events were reported for each antithrombotic regimen.ResultsOf the 539 patients receiving oral anticoagulants, 202 were using oral anticoagulants in combination with either single or dual antiplatelet therapy. Out of 35 patients using triple antithrombotic therapy, four (11.4%) experienced major bleeding. Based on the analysis of 73 patients using anticoagulants in combined with clopidogrel, the results showed that one patient (1.3%) suffered bleeding. Among the 94 patients treated with anticoagulants plus aspirin, seven (7.4%) experienced major bleeding events.ConclusionThe combination of anticoagulants and antiplatelet agents is associated with an elevated bleeding risk. Patients receiving triple antithrombotic therapy experience high prevalence of bleeding. Nonetheless, the group receiving anticoagulant and clopidogrel alone exhibited low prevalence of bleeding risk.