Antiplatelet therapy combined with acenocoumarol in relation to major bleeding, ischaemic stroke and mortality

Area of Science:

• Cardiology
• Pharmacology
• Vascular Medicine

Background:

• Atrial fibrillation (AF) frequently co-occurs with vascular disease, necessitating antiplatelet therapy.
• Patients with AF often require anticoagulation, such as acenocoumarol, alongside antiplatelet agents.
• The safety and efficacy of combined antithrombotic therapy in AF patients with vascular disease require careful evaluation.

Purpose of the Study:

• To investigate the incidence and risk of major bleeding, ischaemic stroke, and mortality.
• To compare outcomes in AF patients on combined acenocoumarol and antiplatelet therapy versus acenocoumarol monotherapy.

Main Methods:

• A real-world cohort of 1361 AF patients on stable acenocoumarol therapy (INR 2.0-3.0) was included.
• Patients were categorized into two groups: combined acenocoumarol plus antiplatelet therapy and acenocoumarol monotherapy.
• Major bleeding (ISTH criteria), ischaemic strokes, and all-cause mortality were recorded over a median follow-up of 6.5 years.

Main Results:

• Combined antithrombotic therapy was associated with a significantly increased risk of major bleeding (HR 1.40, P=0.048).
• No significant difference was observed in mortality (HR 0.95, P=0.674) or ischaemic stroke (HR 1.45, P=0.072) between the groups.
• The incidence rates were 2.83%/year for bleeds, 1.47%/year for ischaemic strokes, and 6.23%/year for deaths.

Conclusions:

• In AF patients, combining antiplatelet therapy with acenocoumarol elevates the risk of major bleeding.
• This combination therapy did not demonstrate a significant reduction in mortality or ischaemic stroke risk compared to acenocoumarol monotherapy.
• Risk stratification for bleeding is crucial when considering combined antithrombotic strategies in AF patients.