Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention

Background and Purpose: Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to asse...

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Autores: Sambola Ayala, Antonia, Mutuberría, Maria, García del Blanco, Bruno, Alonso, Albert, Barrabés, José A., Bueno, Héctor, Alfonso, Fernando, Cequier Fillat, Àngel R., Zueco, Javier, Rodríguez-Leor, Oriol, Tornos, Pilar, García Dorado, David
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2016
País:España
Recursos:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/111147
Acesso em linha:https://hdl.handle.net/2445/111147
Access Level:acceso abierto
Palavra-chave:Persones grans
Fibril·lació auricular
Malalties coronàries
Cirurgia cardiovascular
Malalties de les persones grans
Older people
Atrial fibrillation
Coronary diseases
Cardiovascular surgery
Older people diseases
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oai_identifier_str oai:diposit.ub.edu:2445/111147
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network_name_str España
repository_id_str
spelling Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary interventionSambola Ayala, AntoniaMutuberría, MariaGarcía del Blanco, BrunoAlonso, AlbertBarrabés, José A.Bueno, HéctorAlfonso, FernandoCequier Fillat, Àngel R.Zueco, JavierRodríguez-Leor, OriolTornos, PilarGarcía Dorado, DavidPersones gransFibril·lació auricularMalalties coronàriesCirurgia cardiovascularMalalties de les persones gransOlder peopleAtrial fibrillationCoronary diseasesCardiovascular surgeryOlder people diseasesBackground and Purpose: Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplate- let therapy: aspirin plus clopidogrel) in patients > 75 years of age with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). Methods: A prospective multicenter study was conducted from 2003 to 2012 at 6 Spanish teaching hospitals. A cohort study of consecutive patients with AF undergoing PCI and treated with TT or dual antiplatelet therapy (DAPT) was analyzed. All outcomes were evaluated at 1- year of follow-up. Results: Five hundred and eighty-five patients, 289 (49%) of whom were > 75 years of age (79.6 ± 3.4 years; 33% women) were identified. TT was prescribed in 55.9% of patients at discharge who had a higher thromboembolic risk (CHA 2 DS 2 VASc score: 4.23 ± 1.51 vs 3.76 ± 1.40, p = 0.007 and a higher bleeding risk (HAS-BLED > 3: 88.6% vs 79.2%, p = 0.02) than those on DAPT. Therefore, patients on TT had a lower rate of thromboembolism than those on DAPT (0.6% vs 6.9%, p = 0.004; HR 0.08, 95% CI: 0.01 - 0.70, p = 0.004). Major bleeding events occurred more frequently in patients on TT than in those on DAPT (11.7% vs 2.4%, p = 0.002; HR 5.2, 95% CI: 1.53 - 17.57, p = 0.008). The overall mortality rate was similar in both treatment groups (11.9% vs 13.9%, p = 0.38); however, after adjustment for confounding variables, TT was associated with a reduced mortality rate (HR 0.33, 95% CI: 0.12 - 0.86, p = 0.02). Conclusions In elderly patients with AF undergoing PCI, the use of TT compared to DAPT was associ- ated with reduced thromboembolism and mortality rates, although a higher rate of major bleeding.Public Library of Science (PLoS)2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/111147Articles publicats en revistes (Ciències Clíniques)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1371/journal.pone.0147245PLoS One, 2016, vol. 11, num. 1, p. e0147245https://doi.org/10.1371/journal.pone.0147245cc-by (c) Sambola Ayala, Antonia et al., 2016http://creativecommons.org/licenses/by/3.0/esinfo:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1111472026-05-27T06:46:51Z
dc.title.none.fl_str_mv Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention
title Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention
spellingShingle Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention
Sambola Ayala, Antonia
Persones grans
Fibril·lació auricular
Malalties coronàries
Cirurgia cardiovascular
Malalties de les persones grans
Older people
Atrial fibrillation
Coronary diseases
Cardiovascular surgery
Older people diseases
title_short Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention
title_full Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention
title_fullStr Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention
title_full_unstemmed Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention
title_sort Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention
dc.creator.none.fl_str_mv Sambola Ayala, Antonia
Mutuberría, Maria
García del Blanco, Bruno
Alonso, Albert
Barrabés, José A.
Bueno, Héctor
Alfonso, Fernando
Cequier Fillat, Àngel R.
Zueco, Javier
Rodríguez-Leor, Oriol
Tornos, Pilar
García Dorado, David
author Sambola Ayala, Antonia
author_facet Sambola Ayala, Antonia
Mutuberría, Maria
García del Blanco, Bruno
Alonso, Albert
Barrabés, José A.
Bueno, Héctor
Alfonso, Fernando
Cequier Fillat, Àngel R.
Zueco, Javier
Rodríguez-Leor, Oriol
Tornos, Pilar
García Dorado, David
author_role author
author2 Mutuberría, Maria
García del Blanco, Bruno
Alonso, Albert
Barrabés, José A.
Bueno, Héctor
Alfonso, Fernando
Cequier Fillat, Àngel R.
Zueco, Javier
Rodríguez-Leor, Oriol
Tornos, Pilar
García Dorado, David
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Persones grans
Fibril·lació auricular
Malalties coronàries
Cirurgia cardiovascular
Malalties de les persones grans
Older people
Atrial fibrillation
Coronary diseases
Cardiovascular surgery
Older people diseases
topic Persones grans
Fibril·lació auricular
Malalties coronàries
Cirurgia cardiovascular
Malalties de les persones grans
Older people
Atrial fibrillation
Coronary diseases
Cardiovascular surgery
Older people diseases
description Background and Purpose: Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplate- let therapy: aspirin plus clopidogrel) in patients > 75 years of age with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). Methods: A prospective multicenter study was conducted from 2003 to 2012 at 6 Spanish teaching hospitals. A cohort study of consecutive patients with AF undergoing PCI and treated with TT or dual antiplatelet therapy (DAPT) was analyzed. All outcomes were evaluated at 1- year of follow-up. Results: Five hundred and eighty-five patients, 289 (49%) of whom were > 75 years of age (79.6 ± 3.4 years; 33% women) were identified. TT was prescribed in 55.9% of patients at discharge who had a higher thromboembolic risk (CHA 2 DS 2 VASc score: 4.23 ± 1.51 vs 3.76 ± 1.40, p = 0.007 and a higher bleeding risk (HAS-BLED > 3: 88.6% vs 79.2%, p = 0.02) than those on DAPT. Therefore, patients on TT had a lower rate of thromboembolism than those on DAPT (0.6% vs 6.9%, p = 0.004; HR 0.08, 95% CI: 0.01 - 0.70, p = 0.004). Major bleeding events occurred more frequently in patients on TT than in those on DAPT (11.7% vs 2.4%, p = 0.002; HR 5.2, 95% CI: 1.53 - 17.57, p = 0.008). The overall mortality rate was similar in both treatment groups (11.9% vs 13.9%, p = 0.38); however, after adjustment for confounding variables, TT was associated with a reduced mortality rate (HR 0.33, 95% CI: 0.12 - 0.86, p = 0.02). Conclusions In elderly patients with AF undergoing PCI, the use of TT compared to DAPT was associ- ated with reduced thromboembolism and mortality rates, although a higher rate of major bleeding.
publishDate 2016
dc.date.none.fl_str_mv 2016
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/111147
url https://hdl.handle.net/2445/111147
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1371/journal.pone.0147245
PLoS One, 2016, vol. 11, num. 1, p. e0147245
https://doi.org/10.1371/journal.pone.0147245
dc.rights.none.fl_str_mv cc-by (c) Sambola Ayala, Antonia et al., 2016
http://creativecommons.org/licenses/by/3.0/es
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Sambola Ayala, Antonia et al., 2016
http://creativecommons.org/licenses/by/3.0/es
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Public Library of Science (PLoS)
publisher.none.fl_str_mv Public Library of Science (PLoS)
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,301603

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