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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Antithrombotic therapy after myocardial infarction in patients with atrial fibrillation undergoing percutaneous
Gorav Batra1, Leif Friberg2, David Erlinge3
1Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Science Park, MTC, Dag Hammarskjölds väg 14B, 752 37 Uppsala, Sweden.
Insights
Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) for myocardial infarction (MI) and atrial fibrillation patients is uncertain. Warfarin combined with aspirin or clopidogrel showed similar early and reduced later cardiovascular risk without increased bleeding.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Optimal antithrombotic therapy post-percutaneous coronary intervention (PCI) in patients with myocardial infarction (MI) and atrial fibrillation remains unclear.
- Balancing the risk of thrombotic events against bleeding complications is critical in this patient population.
Purpose of the Study:
- To compare different antithrombotic regimens following PCI in patients with MI and atrial fibrillation.
- To evaluate the composite cardiovascular outcome of all-cause mortality, MI, or ischemic stroke, alongside major bleeding events.
Main Methods:
- Retrospective analysis of 7,116 patients from Swedish registries (October 2005 - December 2012).
- Comparison of antithrombotic therapies including triple therapy, aspirin plus warfarin, clopidogrel plus warfarin, and dual antiplatelet therapy.
- Landmark analysis at 0-90 days and 91-365 days using Cox-regression models.
Main Results:
- Triple therapy showed a non-significant trend towards lower cardiovascular risk (HR 0.78 at 91-365 days) but a higher risk of major bleeds (HR 1.61 at 91-365 days).
- Aspirin plus warfarin was associated with similar early cardiovascular risk and lower late risk (HR 0.62 at 91-365 days) without increased bleeding.
- Clopidogrel plus warfarin demonstrated similar early cardiovascular risk and lower late risk (HR 0.68 at 91-365 days), with no significant increase in major bleeds.
Conclusions:
- Compared to dual antiplatelets, aspirin or clopidogrel plus warfarin therapy is associated with similar short-term and reduced long-term cardiovascular risk, without a higher risk of major bleeding.
- Triple therapy did not significantly reduce cardiovascular outcomes and was associated with an increased risk of major bleeding.
Aims:
Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients with myocardial infarction (MI) and atrial fibrillation is uncertain. In this study, we compared antithrombotic regimes with regard to a composite cardiovascular outcome of all-cause mortality, MI or ischaemic stroke, and major bleeds.
Methods And Results:
Patients between October 2005 and December 2012 were identified in Swedish registries, n = 7116. Landmark 0-90 and 91-365 days of outcome were evaluated with Cox-regressions, with dual antiplatelet therapy as reference. At discharge, 16.2% received triple therapy (aspirin, clopidogrel, and warfarin), 1.9% aspirin plus warfarin, 7.3% clopidogrel plus warfarin, and 60.8% dual antiplatelets. For cardiovascular outcome, adjusted hazard ratio with 95% confidence interval (HR) for triple therapy was 0.86 (0.70-1.07) for 0-90 days and 0.78 (0.58-1.05) for 91-365 days. A HR of 2.16 (1.48-3.13) and 1.61 (0.98-2.66) during 0-90 and 91-365 days, respectively, was observed for major bleeds. For aspirin plus warfarin, HR 0.82 (0.54-1.26) and 0.62 (0.48-0.79) was observed for cardiovascular outcome and 1.30 (0.60-2.85) and 1.01 (0.63-1.62) for major bleeds during 0-90 and 91-365 days, respectively. For clopidogrel plus warfarin, HR of 0.90 (0.68-1.19) and 0.68 (0.49-0.95) was observed for cardiovascular outcome and 1.28 (0.71-2.32) and 1.08 (0.57-2.04) for major bleeds during 0-90 and 91-365 days, respectively.
Conclusion:
Compared to dual antiplatelets, aspirin or clopidogrel plus warfarin therapy was associated with similar 0-90 days and lower 91-365 days of risk of the cardiovascular outcome, without higher risk of major bleeds. Triple therapy was associated with non-significant lower risk of cardiovascular outcome and higher risk of major bleeds.
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