Cited by 269Antiplatelet Therapy and Cardiovascular DiseasesAtrial Fibrillation Management and OutcomesCoronary Interventions and Diagnostics

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Anticoagulant and Antiplatelet Therapy Use in 426 Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention and Stent Implantation

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Ruiz-Nodar, Juan M., Marín, Francisco, Hurtado, José Antonio, Valencia, José, Pinar, Eduardo, Pineda, Javier, Gimeno, Juan Ramón, Sogorb, Francisco, Valdés, Mariano, Lip, Gregory Y.H.·2008·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2007.11.035

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Abstract

Objectives This study was designed to review outcomes in relation to antithrombotic therapy management strategies for patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) with stenting.Background There is limited evidence on the optimal antithrombotic therapy management strategies for patients with AF who undergo PCI with stenting.Methods We reviewed 426 patients (70.9% men, mean age 71.5 +/- 8.5 years) with AF undergoing PCI with stenting between 2001 and 2006. We recorded clinical and demographic characteristics of the patients, stroke risk factors, and antithrombotic therapy use before PCI and at discharge. Clinical follow-up was performed, and all bleeding episodes, thromboembolism, and major adverse cardiac events (MACE) (i.e., death, acute myocardial infarction, or target lesion revascularization) were recorded.Results The most commonly associated comorbidities were hypertension (74.5%), diabetes mellitus (40.2%), chronic renal failure (14.9%), and congestive heart failure (26.7%); 80% of patients had >or=2 stroke risk factors. Of the drugs prescribed at discharge, aspirin plus clopidogrel were used in 174 patients (40.8%), whereas 213 patients (50%) were discharged with triple therapy (coumarins, aspirin, and clopidogrel). Complete follow-up was achieved in 87.5% (median 594 days; range 0 to 2,190). The incidence of adverse events was high (36.6%), with major bleeding in 12.3%, thromboembolic events in 4.2%, and MACE in 32.3%. All-cause mortality was high (22.6%). In a multivariate analysis, non-anticoagulation with coumarins increased mortality (17.8% vs. 27.8%; hazard ratio [HR] = 3.43; 95% confidence interval [CI] 1.61 to 7.54; p = 0.002) and MACE (26.5% vs. 38.7%; HR = 4.9; 95% CI 2.17 to 11.1; p < 0.01) In a Cox-regression analysis, non-anticoagulation (p < 0.01) and age (p = 0.02) were independent predictors of MACE.Conclusions Patients with AF undergoing PCI with stenting represent a high-risk population because of age, comorbidities, and presence of stroke risk factors. These patients have a high mortality and MACE rate, which is reduced by anticoagulation therapy.

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Reply
Sarafoff, N., Byrne, R. A., Mehilli, J., Sibbing, D., Kristensen, S. D., Laugwitz, K., Mæng, M., & Kastrati, A. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.06.1312 · Cited by 13
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Background
The CID Chrono™ cobalt–chromium alloy carbofilm-coated coronary stent system
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BackgroundInfluential
Expert consensus of the French society of geriatrics and gerontology and the French society of cardiology on the management of atrial fibrillation in elderly people
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BackgroundMethodResultInfluential
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BackgroundMethod
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Background
Incidence and Prognostic Implications of Late Bleeding After Myocardial Infarction or Unstable Angina According to Treatment Strategy
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Miyazawa, K., Ogawa, H., Mazurek, M., Shantsila, E., Lane, D., Wolff, A., Akao, M., & Lip, G. (2019) · Circulation Journal · doi:10.1253/circj.cj-19-0546 · Cited by 7
Triple Antithrombotic Therapy: Risky but Sometimes Necessary
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“It has been more difficult to establish concordance of bleeding risk related to dual therapy with a VKA and either ASA or clopidogrel.(10,16,17,20) Two large-scale, nationwide, observational studies have found nearly as high risk of bleeding related to treatment with VKA and clopidogrel as with triple therapy, but a r…”
Influential
Vasodilator-stimulated phosphoprotein-guided Clopidogrel maintenance therapy reduces cardiovascular events in atrial fibrillation patients requiring anticoagulation therapy and scheduled for percutaneous coronary intervention: a prospective cohort study
Hu, C., Zhang, X., Liu, Y., Gao, Y., Zhao, X., Zhou, H., Liu, Y., Liu, Y., & Wang, X. (2018) · BMC Cardiovascular Disorders · doi:10.1186/s12872-018-0853-x · Cited by 8
“[13] regarding combined therapy with coumarins, aspirin, and clopidogrel, the incidence of adverse events in TT was low, with no increase in minor and major bleeding compared to dual antiplatelet therapy (DAPT).”
Background
Intracoronary Beta‐Radiation Therapy for In‐stent Restenosis: Long‐Term Success Rate and Prediction of Failure
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BackgroundInfluential
Meta-Analysis of Oral Anticoagulants with Dual versus Single Antiplatelet Therapy in Patients after Percutaneous Coronary Intervention
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Triple Antithrombotic Therapy for Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention
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Antithrombotic Strategies in Patients with Atrial Fibrillation and Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention
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Consensus d’experts de la Société française de gériatrie et gérontologie et de la Société française de cardiologie, sur la prise en charge de la fibrillation atriale du sujet âgé
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Dual Antiplatelet Therapy and Outcomes in Patients With Atrial Fibrillation and Acute Coronary Syndromes Managed Medically Without Revascularization: Insights From the TRILOGY ACS Trial
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“Neuere Daten bei Patienten mit Vorhofflimmern zeigten nach Stentimplantation (40% DES), dass das Absetzen der Antikoagulation (zur Vermeidung einer Dreifachtherapie) mit einer signifikanten Steigerung der Mortalität von 17,8% auf 27,8% einherging [92].”
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“The most common indication for oral anticoagulation of patients undergoing PCI is atrial fibrillation (about 64%); 45% of patients have an acute coronary syndrome as clinical presentation and DES penetration is less than 40%; (2) As expected, patients on triple therapy have a three- to five-fold overall increase in bl…”
Background
Antithrombotic Strategies and Outcomes in Acute Coronary Syndrome with Atrial Fibrillation
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Triple antithrombotic therapy in patients with atrial fibrillation who have undergone percutaneous coronary intervention with stent implantation
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Prevention of Stroke in Atrial Fibrillation After Coronary Stenting
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Dual Antithrombotic Therapy with Clopidogrel and Novel Oral Anticoagulants in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Real-world Study
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Background
A free-floating left atrial thrombus develops intermittent entrapment in the mid-ventricle during diastole
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Left ventricular thrombosis can still complicate acute myocardial infarction
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Triple antithrombotic therapy with aspirin, a thienopyridine derivative plus oral anticoagulation in patients with atrial fibrillation undergoing coronary stenting.
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Antiplatelet and Antithrombotic Therapy in Patients with Atrial Fibrillation Undergoing Coronary Stenting
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Managing the anticoagulated patient with atrial fibrillation at high risk of stroke who needs coronary intervention
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Bleeding Risk Profile in Patients on Oral Anticoagulation Undergoing Percutaneous Coronary Interventions: A Prospective 24 Months Cohort Study
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“Long-term use of oral NSAIDs or steroids 1 (3) 4 (4) 1.”
BackgroundInfluential
Optimización de la antiagregación en el infarto agudo de miocardio con elevación del segmento ST
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“Th ese factors may contribute to the 3-year mortality of 28% which is much higher than generally in PCI-treated populations (12,21).”
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“There is a lack of published data on appropriate antithrombotic strategies in patients with anticoagulated atrial fibrillation presenting ACS and undergoing PCI with stent implantation.(27) Nevertheless, the guidelines advise the use of the CHADS2 28 and HAS-BLED(29) scores to assess these patients’ bleeding risk.”
Background
Antithrombotic Regimens in Patients With Percutaneous Coronary Intervention Whom an Anticoagulant Is Indicated: A Systematic Review and Network Meta-Analysis
Bunmark, W., Jinatongthai, P., Vathesatogkit, P., Thakkinstian, A., Reid, C. M., Wongcharoen, W., Chaiyakunapruk, N., & Nathisuwan, S. (2018) · Frontiers in Pharmacology · doi:10.3389/fphar.2018.01322 · Cited by 4
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Background
Comparison of clinical outcomes between multiple antithrombotic therapy versus left atrial appendage occlusion with dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation
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Anticoagulant Use as an Independent Risk Factor and Higher In-Hospital Mortality in Patients Showing Alveolar Hemorrhage in Diffuse Lung Disease
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“Combined antiplatelet-anticoagulant therapy was applied to such patients as having cardiovascular disease with atrial fibrillation [22].”
Method
Dual antiplatelet therapy and antithrombotic treatment in patients with acute coronary syndrome--does everyday medical practice reflects current recommendations? A pilot study.
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Épidémiologie des accidents hémorragiques survenant chez les patients sous antivitamine K
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Glycoprotein inhibitors in patients on chronic anticoagulation: Safe enough or too much risk?
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“Indeed, these patients have a high mortality rate, with an increased risk of both thrombotic and haemorrhagic complications (6).”
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Antithrombotic therapy after percutaneous coronary intervention in anticoagulated patients: a fine balance between thrombosis and bleeding
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Bare-Metal Versus Drug-Eluting Stent Placement Among Patients Presenting With Anemia⁎⁎Editorials published in JACC: Cardiovascular Interventions reflect the views of the authors and do not necessarily represent the views of JACC: Cardiovascular Interventions or the American College of Cardiology.
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Triple Antithrombotic Therapy in Patients With Left Ventricular Assist Devices
Krim, S. R., Bennett, A. L., Pfeffer, M., Campbell, P. T., Thai, S. Q., Baetz, B., Wever‐Pinzon, J., Eiswirth, C. C., Desai, S., & Ventura, H. O. (2021) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2021.100940 · Cited by 3
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Update on dual antiplatelet therapy for percutaneous coronary intervention
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Optimizing selection of antithrombotic therapy in patients requiring PCI and long term anticoagulation
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Background
Triple antithrombotic therapy after coronary stenting in the elderly with atrial fibrillation: Necessary or too hazardous?
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Triple Antithrombotic Therapy and Outcomes in Post‐PCI Patients Undergoing Non‐cardiac Surgery
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“While two prior studies demonstrate reduction of adverse cardiac events with triple therapy [1, 4], four demonstrated no relationship with outcomes [2, 3, 6, 26].”
Result
Antithrombotic Therapy for Stroke Patients with Cardiovascular Disease
Gusdon, A. M., Farrokh, S., & Grotta, J. C. (2021) · Seminars in Neurology · doi:10.1055/s-0041-1726331 · Cited by 4
Combined Use of Warfarin and Oral P2Y12 Inhibitors in Patients With Atrial Fibrillation and Acute Coronary Syndrome
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Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: Where Are We Now?
D’Angelo, R. G., McGiness, T. P., & Waite, L. H. (2018) · Annals of Pharmacotherapy · doi:10.1177/1060028018766837 · Cited by 2
Issues of antithrombotic therapy in ACS patients with atrial fibrillation
Kaydalova, N. A., Koroleva, L. Y., Ковалева, Г. В., Paykova, N. N., Носов, В. П., Volkova, A. T., & Koryazina, A. M. (2018) · Kardiologiia · doi:10.18087/cardio.2422 · Cited by 2
Antithrombotic Regimens in Patients With Indication for Long-Term Anticoagulation Undergoing Coronary Interventions—Systematic Analysis, Review of Literature, and Implications on Management
Deshmukh, A. R., Hilleman, D. E., Core, M. A. D., & Nair, C. K. (2011) · American Journal of Therapeutics · doi:10.1097/mjt.0b013e31820b867b · Cited by 2
Balancing Antiplatelet and Anticoagulant Therapies in Patients with Cardiovascular Disease
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Triple therapy (aspirin, clopidogrel and oral anticoagulant) after percutaneous coronary intervention: another call for personalized medicine
Tanrikulu, A. M., & Ağırbaşlı, M. A. (2013) · The Anatolian Journal of Cardiology · doi:10.5152/akd.2013.147 · Cited by 2
“Deadly triad of triple therapy; 3 adverse events to be considered in selecting triple therapy are associated with a risk of death that occurs among one-fourth to one-half of patients (2, 14, 21) Major”
Background
Antithrombotic therapy and bleeding risk in atrial fibrillation. Fewer unanswered questions
Ruiz-Nodar, J. M., & Marín, F. R. (2013) · Thrombosis and Haemostasis · doi:10.1160/th13-01-0058 · Cited by 2
“Nonetheless, patients with AF presenting with an ACS or with chronic ischaemic heart disease undergoing percutaneous coronary intervention with stent implantation represent a complex management problem (17, 18, 20).”
Background

Authors: Ruiz-Nodar, J. M., Marín, F., Hurtado, J. A., Valencia, J., Pinar, E., Pineda, J., Gimeno, J. R., Sogorb, F., Valdés, M., & Lip, G. Y. H.
Affiliations: Hospital General Universitario de Alicante Doctor Balmis (ES)
Instituto de Salud Carlos III (ES)
Hospital Universitario Virgen de la Arrixaca (ES)
Birmingham City Hospital (GB)
Corresponding author: Lip, Gregory Y.H.
ORCID: Ruiz-Nodar, Juan M.
Marín, Francisco
Valencia, José
Pinar, Eduardo
Pineda, Javier
Gimeno, Juan Ramón
Sogorb, Francisco
Lip, Gregory Y.H.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2008-02
Volume: 51
Issue: 8
Pages: 818-825
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2007.11.035
OpenAlex: W1475865131
Cited by: 269
References: 25
Citations by year: 2026: 3 · 2025: 1 · 2024: 2 · 2023: 5 · 2022: 3 · 2021: 10 · 2020: 3 · 2019: 10 · 2018: 11 · 2017: 7 · 2016: 16 · 2015: 33 · 2014: 24 · 2013: 27 · 2012: 15
FWCI: 24.00
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 2029 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
Keywords: atrial fibrillation, percutaneous coronary intervention, coronary stenting, antithrombotic therapy, anticoagulation, antiplatelet therapy, clopidogrel, aspirin, coumarins, triple therapy, major adverse cardiac events, major bleeding, thromboembolism, all-cause mortality, stroke risk factors, dual antiplatelet therapy
MeSH terms: Aged, Anticoagulants, Atrial Fibrillation, Female, Heart Diseases, Humans, Male, Platelet Aggregation Inhibitors, Prognosis, Retrospective Studies, Risk Factors, Thromboembolism, Stents, Angioplasty, Balloon, Coronary, Postoperative Hemorrhage

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Anticoagulant and Antiplatelet Therapy Use in 426 Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention and Stent Implantation

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