title: Major bleeding complications related to combined antithrombotic therapy in atrial fibrillation patients 12 months after coronary artery stenting.
abstract: OBJECTIVE
  Many patients with atrial fibrillation (AF) and coronary artery stent deployment are given both antiplatelet drug and warfarin. Little information is available as to the relationship between the antithrombotic therapies in the late phase after stenting and the clinical outcomes of these patients. We examined the clinical outcomes of AF patients 12 months after coronary artery stenting.
  
  
  METHODS
  We retrospectively examined 146 patients and classified them into three groups according to the antithrombotic therapies [dual antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT) plus warfarin, and DAPT plus warfarin] 12 months after stenting. We defined the primary endpoint as Thrombolysis in Myocardial Infarction major bleeding and the secondary endpoint as a composite of adverse events (CAE: all-cause death, nonfatal myocardial infarction, intracranial bleeding, and cerebral infarction).
  
  
  RESULTS
  During a median follow-up of 37 months, major bleeding and CAE were observed in 14 (9.6%) and 46 (31.5%) patients, respectively. DAPT plus warfarin was an independent risk factor for major bleeding in a multivariate Cox hazard regression model after adjustment for age, gender, and the type of AF (hazard ratio: 4.20; 95% confidence interval: 1.13-17.27; p=0.033). No significant clinical variables were found for CAE.
  
  
  CONCLUSIONS
  Prolonged use of DAPT with warfarin significantly increases the risk of major bleeding in AF patients after coronary artery stenting. Individualized antithrombotic treatment is required in these patients to prevent major bleeding.
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan. Electronic address: hkawai@fujita-hu.ac.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawai
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiology, Nagoya Memorial Hospital, Nagoya, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Harigaya
authors.affiliation: Department of Cardiology, Hekinan Municipal Hospital, Hekinan, Japan.
authors.forename: Kan
authors.initials: K
authors.lastname: Sano
authors.affiliation: Department of Cardiology, Daido Hospital, Nagoya, Japan.
authors.forename: Hidemaro
authors.initials: H
authors.lastname: Takatsu
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Muramatsu
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Naruse
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sobue
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Sadako
authors.initials: S
authors.lastname: Motoyama
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Sarai
authors.affiliation: Department of Medical Statistics, Fujita Health University, Toyoake, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Cardiology, Daido Hospital, Nagoya, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Arakawa
authors.affiliation: Department of Cardiology, Nagoya Memorial Hospital, Nagoya, Japan.
authors.forename: Shino
authors.initials: S
authors.lastname: Kan
authors.affiliation: Department of Cardiology, Hekinan Municipal Hospital, Hekinan, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sugiura
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications*; D003324:Coronary Artery Disease / Q000628:therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin
keywords: Antithrombotic therapy; Atrial fibrillation; Coronary artery stent