Increased major bleeding complications related to triple antithrombotic therapy usage in patients with atrial fibrillation undergoing percutaneous coronary artery stenting.
BACKGROUND
The optimal antithrombotic therapy strategy for atrial fibrillation (AF) patients who undergo percutaneous coronary intervention with stent implantation (PCI-S) is unknown. We assessed the safety of antithrombotic therapy strategies in AF patients with indication for oral anticoagulation (OAC) undergoing PCI-S.


METHODS
We studied consecutive AF patients with indication for OAC who underwent PCI-S. We compared patients that received triple antithrombotic therapy (TT) [aspirin, clopidogrel, and coumadin] against other regimes (non-TT) after PCI-S. The primary end point was defined as the occurrence of major bleeding complications that were termed as early major bleeding (EMB) [< or = 48 h] or late major bleeding (LMB) [> 48 h]. Clinical follow-up was performed, and complications were recorded.


RESULTS
We studied 104 patients (mean age +/- SD, 72 +/- 8 years; 70% men); TT was used in 51 patients (49%). TT was associated with a higher incidence of LMB (21.6% vs non-TT, 3.8%; p = 0.006) but not of EMB (5.8% vs non-TT, 11.3%; p = 0.33). In multivariate analyses, glycoprotein (GP) IIb/IIIa inhibitor use (hazard ratio [HR], 13.5; 95% confidence interval [CI], 1.7 to 108.3; p = 0.014) and PCI-S of three vessels or left main artery disease (HR, 7.9; 95% CI, 1.6 to 39.2; p = 0.01) were independent predictors for EMB. TT use (HR, 7.1; 95% CI, 1.5 to 32.4; p = 0.012), the occurrence of EMB (HR, 6.7; 95% CI, 1.8 to 25.3; p = 0.005), and baseline anemia (HR, 3.8; 95% CI, 1.2 to 12.5; p = 0.027) were independent predictors for LMB. No differences in major cardiovascular events were observed in patients treated with TT vs non-TT (25.5% vs 21.0%; p = 0.53).


CONCLUSIONS
A high rate of major bleeding is observed in AF patients with indication for OAC undergoing PCI-S who receive TT. GP IIb/IIIa inhibitor use and multivessel/left main artery disease during PCI-S were independent predictors for EMB, while TT use, occurrence of EMB, and baseline anemia were independent predictors for LMB.
Manzano-Fernández
Sergio
S
Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Pastor
Francisco J
FJ
Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Marín
Francisco
F
Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Cambronero
Francisco
F
Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Caro
Cesar
C
Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Pascual-Figal
Domingo A
DA
Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Garrido
Iris P
IP
Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Pinar
Eduardo
E
Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Valdés
Mariano
M
Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Lip
Gregory Y H
GYH
University Department of Medicine, City Hospital, Birmingham, UK. Electronic address: g.y.h.lip@bham.ac.uk.
D054058:Acute Coronary Syndrome / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin