title: Antithrombotic therapy and outcomes after ICD implantation in patients with atrial fibrillation and coronary artery disease: an analysis from the National Cardiovascular Data Registry (NCDR)®.
abstract: BACKGROUND
  Management of antithrombotic agents after implantable cardioverter defibrillator implantation is challenging, particularly among patients with atrial fibrillation and coronary artery disease.
  
  
  RESULTS
  Using data from National Cardiovascular Data Registry(®) Implantable Cardioverter Defibrillator Registry(™) linked with Medicare claims data, we identified 25 180 patients with atrial fibrillation and coronary artery disease who underwent implantable cardioverter defibrillator implantation. Patients were categorized into 5 different groups according to antithrombotic agents prescribed at discharge (any 1 antiplatelet agent [A, n=6538], dual antiplatelet therapy [DA, n=3414], warfarin [n=5264], warfarin+A [n=7994], warfarin+DA [n=1970]). We assessed the primary outcomes occurring within 30 days of hospital discharge. Combinations of DA (adjusted hazard ratio [HR]: 1.39; 95% CI: 1.03 to 1.87), warfarin+A (adjusted HR: 1.32; 95% CI: 1.03 to 1.69), and warfarin+DA (adjusted HR: 2.03; 95% CI: 1.49 to 2.77) were associated with a higher bleeding risk. The risk of major adverse cardiovascular events was higher in patients discharged with A (adjusted HR: 1.69; 95% CI: 1.33 to 2.16), DA (adjusted HR: 2.17; 95% CI: 1.66 to 2.83), and DA+warfarin (adjusted HR: 1.61; 1.16 to 2.24). There was no association between postdischarge antithrombotic agents and thromboembolic events or device-related complications.
  
  
  CONCLUSIONS
  Short-term bleeding risk and major adverse cardiovascular events differ with usage patterns of antithrombotic agents, while the risk of thromboembolic events and device-related complications is relatively constant. These data may help clinicians balance risks and benefits when choosing antithrombotic therapy following implantable cardioverter defibrillator implantation.
authors: Section of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI (H.G., B.K.N.).
authors: Hamid
authors: H
authors: Ghanbari
authors: Section of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI (H.G., B.K.N.).
authors: Brahmajee K
authors: BK
authors: Nallamothu
authors: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (Y.W., J.P.C.).
authors: Yongfei
authors: Y
authors: Wang
authors: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (Y.W., J.P.C.).
authors: Jeptha P
authors: JP
authors: Curtis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology / Q000628:therapy*; D003324:Coronary Artery Disease / Q000150:complications*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010351:Patient Discharge; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012042:Registries / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014859:Warfarin / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin
keywords: anticoagulants; arrhythmia; complications; defibrillation
references: Pharmacoepidemiol Drug Saf. 2010 Jun;19(6):596-603
references: 20140892
references: J Am Coll Cardiol. 2013 Sep 10;62(11):981-9
references: 23747760
references: Thromb Haemost. 2010 Jan;103(1):13-28
references: 20062939
references: N Engl J Med. 2009 May 14;360(20):2066-78
references: 19336502
references: Heart Rhythm. 2008 Sep;5(9):1359-63
references: 18774117
references: Med Care. 2007 Oct;45(10 Supl 2):S103-7
references: 17909367
references: J Am Coll Cardiol. 2006 Jun 20;47(12):2493-7
references: 16781379
references: Med Care. 2005 May;43(5):480-5
references: 15838413
references: Comput Methods Programs Biomed. 2004 Jul;75(1):45-9
references: 15158046
references: Clin Cardiol. 2012 Nov;35(11):649-57
references: 23070696
references: Lancet. 2013 Mar 30;381(9872):1107-15
references: 23415013
references: J Am Coll Cardiol. 2012 Oct 16;60(16):1484-8
references: 22999725
references: Circ Cardiovasc Qual Outcomes. 2012 Jan;5(1):134-40
references: 22253370
references: Circulation. 2011 Apr 19;123(15):1587-93
references: 21464054
references: Circ Arrhythm Electrophysiol. 2010 Aug;3(4):312-8
references: 20558847
references: J Am Coll Cardiol. 2010 May 25;55(21):2376-82
references: 20488310