Cited by 413Atrial Fibrillation Management and OutcomesAntiplatelet Therapy and Cardiovascular DiseasesAcute Myocardial Infarction Research

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Bleeding After Initiation of Multiple Antithrombotic Drugs, Including Triple Therapy, in Atrial Fibrillation Patients Following Myocardial Infarction and Coronary Intervention: A Nationwide Cohort Study

Lamberts, Morten, Olesen, Jonas Bjerring, Ruwald, Martin Huth, Hansen, Carolina Malta, Karasoy, Deniz, Kristensen, Søren Lund, Køber, Lars, Torp-Pedersen, Christian, Gislason, Gunnar Hilmar, Hansen, Morten Lock·2012·Circulation

DOI 10.1161/circulationaha.112.114967

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Abstract

Background—: Uncertainty remains over optimal antithrombotic treatment of patients with atrial fibrillation presenting with myocardial infarction and/or undergoing percutaneous coronary intervention. We investigated the risk and time frame for bleeding following myocardial infarction/percutaneous coronary intervention in patients with atrial fibrillation according to antithrombotic treatment. Methods and Results—: Patients with atrial fibrillation and admitted with myocardial infarction or for percutaneous coronary intervention between 2000 and 2009 (11 480 subjects, mean age 75.6 years [SD ±10.3], males 60.9%) were identified by individual level linkage of nationwide registries in Denmark. Fatal or nonfatal (requiring hospitalization) bleeding was determined according to antithrombotic treatment regimen: triple therapy (TT) with vitamin K antagonist (VKA)+aspirin+clopidogrel, VKA+antiplatelet, and dual antiplatelet therapy with aspirin+clopidogrel. We calculated crude incidence rates and adjusted hazard ratios by Cox regression models. Within 1 year, 728 bleeding events were recorded (6.3%); 79 were fatal (0.7%). Within 30 days, rates were 22.6, 20.3, and 14.3 bleeding events per 100 person-years for TT, VKA+antiplatelet, and dual antiplatelet therapy, respectively. Both early (within 90 days) and delayed (90–360 days) bleeding risk with TT exposure in relation to VKA+antiplatelet was increased; hazard ratio 1.47 (1.04;2.08) and 1.36 (0.95;1.95), respectively. No significant difference in thromboembolic risk was observed for TT versus VKA+antiplatelet; hazard ratio, 1.15 (0.95;1.40). Conclusions—: High risk of bleeding is immediately evident with TT after myocardial infarction/percutaneous coronary intervention in patients with atrial fibrillation. A continually elevated risk associated with TT indicates no safe therapeutic window, and TT should only be prescribed after thorough bleeding risk assessment of patients.

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Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial
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“of total bleeding ( fatal events ) / person years at risk Triple therapy VKA + antiplatelet therapy Dual antiplatelet therap y VKA monotherapy Single antiplatelet therapy 27 ( 1) / 119 30 ( 2) / 148 37 ( 1) / 259 5 ( 1) / 59 48 ( 11) / 309 39 ( 0) / 193 38 ( 3) / 291 40 ( 2) / 596 9 ( 0) / 104 54 (12) / 561 21 ( 3) /…”

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BackgroundInfluential
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BackgroundResultInfluential
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Bleeding and ischaemic outcomes in patients treated with dual or triple antithrombotic therapy: systematic review and meta-analysis
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Authors: Lamberts, M., Olesen, J. B., Ruwald, M. H., Hansen, C. M., Karasoy, D., Kristensen, S. L., Køber, L., Torp-Pedersen, C., Gislason, G. H., & Hansen, M. L.
Affiliations: Copenhagen University Hospital (DK)
Gentofte Hospital (DK)
ORCID: Lamberts, Morten
Olesen, Jonas Bjerring
Ruwald, Martin Huth
Hansen, Carolina Malta
Karasoy, Deniz
Kristensen, Søren Lund
Køber, Lars
Torp-Pedersen, Christian
Gislason, Gunnar Hilmar
Hansen, Morten Lock
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2012-09-04
Volume: 126
Issue: 10
Pages: 1185-1193
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/circulationaha.112.114967
OpenAlex: W2108659563
Cited by: 413
References: 0
Citations by year: 2026: 7 · 2025: 6 · 2024: 9 · 2023: 10 · 2022: 16 · 2021: 24 · 2020: 36 · 2019: 42 · 2018: 42 · 2017: 43 · 2016: 37 · 2015: 40 · 2014: 41 · 2013: 53 · 2012: 6
FWCI: 28.82
Type: journal article
Language: en
Open access: closed
Locations: Circulation (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 › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords: atrial fibrillation, bleeding risk, triple therapy, vitamin K antagonists, clopidogrel, aspirin, antiplatelet therapy, dual antiplatelet therapy, myocardial infarction, percutaneous coronary intervention, thromboembolic risk, bleeding risk assessment
MeSH terms: Clopidogrel, Aged, Aged, 80 and over, Aspirin, Atrial Fibrillation, Denmark, Drug Therapy, Combination, Female, Fibrinolytic Agents, Hemorrhage, Humans, Male, Middle Aged, Myocardial Infarction, Platelet Aggregation Inhibitors, Registries, Risk Factors, Ticlopidine, Vitamin K, Cohort Studies, Comorbidity, Angioplasty, Balloon, Coronary, Stroke, Acute Coronary Syndrome

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Bleeding After Initiation of Multiple Antithrombotic Drugs, Including Triple Therapy, in Atrial Fibrillation Patients Following Myocardial Infarction and Coronary Intervention: A Nationwide Cohort Study

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