Archive for the ‘Antiplatelet drugs’ Category

Journal Club 3 October 2012


Bleeding After Initiation of Multiple Antithrombotic Drugs, Including Triple Therapy, in Atrial Fibrillation Patients Following Myocardial Infarction and Coronary Intervention





Uncertainty remains over optimal antithrombotic treatment of patients with atrial fibrillation presenting with
myocardial infarction and/or undergoing percutaneous coronary intervention. We investigated the risk and time frame
for bleeding following myocardial infarction/percutaneous coronary intervention in patients with atrial fibrillation
according to antithrombotic treatment.

Methods and Results

Patients with atrial fibrillation and admitted with myocardial infarction or for percutaneous coronary
intervention between 2000 and 2009 (11 480 subjects, mean age 75.6 years [SD 10.3], males 60.9%) were identified by
individual level linkage of nationwide registries in Denmark. Fatal or nonfatal (requiring hospitalization) bleeding was
determined according to antithrombotic treatment regimen: triple therapy (TT) with vitamin K antagonist
(VKA)aspirinclopidogrel, VKAantiplatelet, and dual antiplatelet therapy with aspirinclopidogrel. We calculated crude
incidence rates and adjusted hazard ratios by Cox regression models. Within 1 year, 728 bleeding events were recorded (6.3%); 79 were fatal (0.7%). Within 30 days, rates were 22.6, 20.3, and 14.3 bleeding events per 100 person-years for TT, VKAantiplatelet,
and dual antiplatelet therapy, respectively. Both early (within 90 days) and delayed (90–360 days) bleeding risk with TT exposure
in relation to VKAantiplatelet was increased; hazard ratio 1.47 (1.04;2.08) and 1.36 (0.95;1.95), respectively. No significant
difference in thromboembolic risk was observed for TT versus VKAantiplatelet; hazard ratio, 1.15 (0.95;1.40).


High risk of bleeding is immediately evident with TT after myocardial infarction/percutaneous coronary
intervention in patients with atrial fibrillation. A continually elevated risk associated with TT indicates no safe therapeutic window, and TT should only be prescribed after thorough bleeding risk assessment of patients.

Other Material

The editorial is here.