Cited by 855Atrial Fibrillation Management and OutcomesAntiplatelet Therapy and Cardiovascular DiseasesBlood Coagulation and Thrombosis Mechanisms

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Risk of Bleeding With Single, Dual, or Triple Therapy With Warfarin, Aspirin, and Clopidogrel in Patients With Atrial Fibrillation

Hansen, Morten L., Sørensen, Rikke, Clausen, Mette T., Fog-Petersen, Marie Louise, Raunsø, Jakob, Gadsbøll, Niels, Gislason, Gunnar H., Folke, Fredrik, Andersen, Søren S., Schramm, Tina K., Abildstrøm, Steen Z., Poulsen, Henrik E., Køber, Lars, Torp-Pedersen, Christian·2010·Archives of Internal Medicine

DOI 10.1001/archinternmed.2010.271

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Abstract

BACKGROUND: Patients with atrial fibrillation (AF) often require anticoagulation and platelet inhibition, but data are limited on the bleeding risk of combination therapy. METHODS: We performed a cohort study using nationwide registries to identify all Danish patients surviving first-time hospitalization for AF between January 1, 1997, and December 31, 2006, and their posthospital therapy of warfarin, aspirin, clopidogrel, and combinations of these drugs. Cox proportional hazards models were used to estimate risks of nonfatal and fatal bleeding. RESULTS: A total of 82,854 of 118,606 patients (69.9%) surviving AF hospitalization had at least 1 prescription filled for warfarin, aspirin, or clopidogrel after discharge. During mean (SD) follow-up of 3.3 (2.6) years, 13,573 patients (11.4%) experienced a nonfatal or fatal bleeding. The crude incidence rate for bleeding was highest for dual clopidogrel and warfarin therapy (13.9% per patient-year) and triple therapy (15.7% per patient-year). Using warfarin monotherapy as a reference, the hazard ratio (95% confidence interval) for the combined end point was 0.93 (0.88-0.98) for aspirin, 1.06 (0.87-1.29) for clopidogrel, 1.66 (1.34-2.04) for aspirin-clopidogrel, 1.83 (1.72-1.96) for warfarin-aspirin, 3.08 (2.32-3.91) for warfarin-clopidogrel, and 3.70 (2.89-4.76) for warfarin-aspirin-clopidogrel. CONCLUSIONS: In patients with AF, all combinations of warfarin, aspirin, and clopidogrel are associated with increased risk of nonfatal and fatal bleeding. Dual warfarin and clopidogrel therapy and triple therapy carried a more than 3-fold higher risk than did warfarin monotherapy.

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Background
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Background
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Background
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Background
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Do Not Use Novel Antiplatelet Agents in Patients on Oral Anticoagulants After Stenting
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Background
Incidence, Current Guidelines and Management of Gastrointestinal Bleeding after Transcatheter Aortic Valve Replacement: A Systematic Review
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Influential
A qualitative evaluation of barriers and facilitators to a large-scale antithrombotic stewardship intervention in the United States Veterans Healthcare system
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S2k-Leitlinie Gastrointestinale Blutung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)
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Background
Drug-Drug Interactions with Anticoagulants and Antiplatelets
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Background
Late Major Hemoptysis After Lung Volume Reduction With Coils Induced by Dual Antiaggregation Therapy
Valenti, A., Casutt, A., Koutsokera, A., Noetzli, J., Perentes, J. Y., Krueger, T., Pons, M., Nicod, L. P., & Lovis, A. (2016) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2015.06.045 · Cited by 1
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Background
Edoxaban zur Schlaganfallprophylaxe bei Patienten mit nicht-valvulärem Vorhofflimmern und zur Behandlung venöser Thromboembolien: ein interdisziplinäres Positionspapier
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“Großangelegte retrospektive als auch prospektive Studien konnte zeigen, dass schwere Blutungsereignisse unter Acetylsalicylsäure (ASS) entgegen der subjektiv wahrgenommenen Sicherheit der Substanz vergleichbar häufig aufzutreten scheinen als unter VKA [15, 16].”
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Aktuelle Indikationsstellung zur Vorhofohrokkluderimplantation
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“7 Antiplatelet therapy SAPT, n (%) 7 (14) 7 (16) DAPT, n (%) 2 (4) 1 (2) CHA2DS2Vasc 0–1, n (%) 19 (39) 13 (29) 2–3, n (%) 19 (39) 21 (48) ⩾4, n (%) 11 (22) 10 (23) HAS-BLED ⩽2, n (%) 90 (44) 98 (43) ⩾3, n (%) 10 (5) 2 (1) Anticoagulation strategy Warfarin (%) N/A 37 (84) NOAC (%) N/A 5 (11) LMWH (%) N/A 2 (5)”
In-hospital Bleeding Outcomes of Oral Anticoagulant and Dual Antiplatelet Therapy During Percutaneous Coronary Intervention: An Analysis From the Japanese Nationwide Registry
Yashima, F., Inohara, T., Nishida, H., Shimoji, K., Ueno, K., Noma, S., Yamaji, K., Ishii, H., Tanaka, N., Kohsaka, S., et al. (2021) · Journal of Cardiovascular Pharmacology · doi:10.1097/fjc.0000000000001006 · Cited by 1
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Method
Polypharmacy and Integrated Care
Mair, A. R., & Alonso, A. (2021) · Springer eBooks · doi:10.1007/978-3-030-69262-9_27 · Cited by 1
Comparison of predictive value of risk scores for gastrointestinal bleeding in antiplatelet therapy
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ACEi/ARBs associate with lower incidence of gastrointestinal bleeding in peritoneal dialysis patients
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Background
Role of cerebral microbleeds in acute ischemic stroke and atrial fibrillation
Wang, M., Yang, Y., Luan, M., Wang, Y., Zhong, M., Xu, L., & Zheng, X. (2022) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-022-02761-y · Cited by 1
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Background
Percutaneous Coronary Intervention and Bleeding Complications
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A Cardiologists’ Survey on the Use of Anticoagulants and Antiplatelets in Patients With Atrial Fibrillation and Acute Coronary Syndrome or Those Undergoing Percutaneous Coronary Intervention in India
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Optimal Antithrombotic Therapy Beyond 1-Year After Coronary Revascularization in Patients With Atrial Fibrillation
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Authors: Hansen, M. L., Sørensen, R., Clausen, M. T., Fog-Petersen, M. L., Raunsø, J., Gadsbøll, N., Gislason, G. H., Folke, F., Andersen, S. S., Schramm, T. K., Abildstrøm, S. Z., Poulsen, H. E., Køber, L., & Torp-Pedersen, C.
Affiliations: Copenhagen University Hospital (DK)
ORCID: Hansen, Morten L.
Sørensen, Rikke
Raunsø, Jakob
Gislason, Gunnar H.
Folke, Fredrik
Poulsen, Henrik E.
Køber, Lars
Torp-Pedersen, Christian
Venue: Archives of Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2010-09-13
Volume: 170
Issue: 16
Pages: 1433-41
ISSN: 0003-9926 (ISSN-L)
DOI: 10.1001/archinternmed.2010.271
OpenAlex: W2144471064
Cited by: 855
References: 45
Citations by year: 2026: 16 · 2025: 23 · 2024: 23 · 2023: 25 · 2022: 41 · 2021: 37 · 2020: 64 · 2019: 83 · 2018: 63 · 2017: 75 · 2016: 80 · 2015: 68 · 2014: 63 · 2013: 76 · 2012: 63
FWCI: 42.19
Type: journal article
Language: en
Open access: closed
Locations: Archives of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
Keywords: atrial fibrillation, bleeding risk, warfarin, aspirin, clopidogrel, combination antithrombotic therapy, triple therapy, dual therapy, anticoagulation, platelet aggregation inhibition, fatal bleeding
MeSH terms: Clopidogrel, Aged, Anticoagulants, Aspirin, Atrial Fibrillation, Brain Ischemia, Denmark, Drug Therapy, Combination, Female, Hemorrhage, Humans, Male, Registries, Risk, Ticlopidine, Warfarin, Cohort Studies, Comorbidity, Incidence, Proportional Hazards Models, Stroke

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Risk of Bleeding With Single, Dual, or Triple Therapy With Warfarin, Aspirin, and Clopidogrel in Patients With Atrial Fibrillation

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