title: Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy.
abstract: BACKGROUND
  Patients with arterial disease receiving antiplatelet agents may develop venous thromboembolism (VTE) and need anticoagulant therapy, although concomitant use of these drugs may increase bleeding risk. We analyzed RIETE data and compared clinical outcomes depending on decision to discontinue or maintain antiplatelet therapy at VTE diagnosis.
  
  
  METHODS
  Consecutive patients with acute VTE were enrolled in RIETE. Only patients receiving antiplatelet therapy at baseline were included in this analysis. Primary outcomes were: rate of subsequent ischemic events, major bleeding or death during anticoagulation course.
  
  
  RESULTS
  1178 patients who received antiplatelet drugs at VTE diagnosis were included. Antiplatelet therapy was discontinued in 62% of patients. During anticoagulation course, patients also receiving antiplatelet therapy had higher rates of lower limb amputations (2.28 vs. 0.21 events per 100 patients-years; p<0.01), any ischemic events (5.7 vs. 2.28 events per 100 patients-years; p<0.05) or death (23.6 vs. 13.9 deaths per 100 patients-years; p<0.01). No differences in the rate of major bleeding or recurrent VTE were revealed. In matched analysis, patients on antiplatelet therapy were found to have a significantly higher rate of limb amputations (odds ratio: 15.3; 95% CI: 1.02-229) and an increased number of composite outcomes including all-cause deaths, arterial and VTE events (odds ratio: 1.46; CI: 1.03-2.06), with no differences in major bleeding rate.
  
  
  CONCLUSIONS
  Concomitant anticoagulant and antiplatelet therapy in patients with VTE and arterial disease is not associated with increased risk for bleeding, recurrent VTE or death. The worse outcome observed in patients who continued antiplatelet therapy requires further investigations.
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Israel. Electronic address: i_tzoran@rambam.health.gov.il.
authors.forename: Inna
authors.initials: I
authors.lastname: Tzoran
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Brenner
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Israel.
authors.forename: Gleb
authors.initials: G
authors.lastname: Sakharov
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Santa Lucía, Cartagena, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Trujillo-Santos
authors.affiliation: Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Lorenzo
authors.affiliation: Department of Internal Medicine, Hospital Infanta Sofía, Madrid, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Madridano
authors.affiliation: Department of Internal Medicine, Hospital Universitario Puerto Real, Cádiz, Spain.
authors.forename: Juan Bosco
authors.initials: JB
authors.lastname: López-Sáez
authors.affiliation: Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Anticoagulant; Antiplatelet; Venous thromboembolism