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Published on: February 26, 2013
Impact of Triple Therapy in Elderly Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention
Antonia Sambola1, Maria Mutuberría1, Bruno García Del Blanco1
1Cardiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
Triple therapy (TT) reduced thromboembolism and mortality in elderly atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI). However, TT also increased the risk of major bleeding events compared to dual antiplatelet therapy (DAPT).
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) face elevated risks of thromboembolism and bleeding.
- Optimal antithrombotic strategies for this high-risk population remain a clinical challenge.
Purpose of the Study:
- To evaluate the efficacy and safety of triple therapy (TT), comprising oral anticoagulation plus aspirin and clopidogrel, versus dual antiplatelet therapy (DAPT) in patients aged 75 years or older with AF undergoing PCI.
Main Methods:
- A prospective, multicenter cohort study involving 585 patients (289 aged ≥75 years) treated between 2003 and 2012.
- Outcomes including thromboembolism, major bleeding, and mortality were assessed at 1-year follow-up for patients on TT versus DAPT.
Main Results:
- Patients on TT exhibited higher baseline thromboembolic (CHA2DS2VASc score) and bleeding (HAS-BLED ≥3) risks.
- TT was associated with significantly lower rates of thromboembolism (0.6% vs 6.9%, p=0.004) but higher rates of major bleeding (11.7% vs 2.4%, p=0.002).
- While overall mortality was similar, adjusted analysis revealed TT was linked to reduced mortality (HR 0.33, p=0.02).
Conclusions:
- In elderly AF patients undergoing PCI, triple therapy demonstrates a significant reduction in thromboembolic events and mortality compared to dual antiplatelet therapy.
- The benefit of triple therapy is accompanied by an increased risk of major bleeding, necessitating careful patient selection and monitoring.
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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