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Comparison of Long-Term Outcomes Between Combination Antiplatelet and Anticoagulant Therapy and Anticoagulant Monotherapy in Patients With Atrial Fibrillation and Left Atrial Thrombi
Background: Anticoagulation for patients with atrial fibrillation (AF) complicated by left atrial thrombi (LAT) is a frequent cause of bleeding complications, but risk factors remain unknown. Methods and Results: Of 3,139 AF patients who underwent transesophageal echocardiography, 82 with LAT under...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Japanese Circulation Society
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819665/ https://www.ncbi.nlm.nih.gov/pubmed/33693270 http://dx.doi.org/10.1253/circrep.CR-20-0036 |
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author | Sunaga, Akihiro Hikoso, Shungo Nakatani, Daisaku Inoue, Koichi Okuyama, Yuji Egami, Yasuyuki Kashiwase, Kazunori Hirata, Akio Masuda, Masaharu Furukawa, Yoshio Watanabe, Tetsuya Mizuno, Hiroya Okada, Katsuki Dohi, Tomoharu Kitamura, Tetsuhisa Komukai, Sho Kurakami, Hiroyuki Yamada, Tomomi Takeda, Toshihiro Kida, Hirota Oeun, Bolrathanak Kojima, Takayuki Minamiguchi, Hitoshi Sakata, Yasushi |
author_facet | Sunaga, Akihiro Hikoso, Shungo Nakatani, Daisaku Inoue, Koichi Okuyama, Yuji Egami, Yasuyuki Kashiwase, Kazunori Hirata, Akio Masuda, Masaharu Furukawa, Yoshio Watanabe, Tetsuya Mizuno, Hiroya Okada, Katsuki Dohi, Tomoharu Kitamura, Tetsuhisa Komukai, Sho Kurakami, Hiroyuki Yamada, Tomomi Takeda, Toshihiro Kida, Hirota Oeun, Bolrathanak Kojima, Takayuki Minamiguchi, Hitoshi Sakata, Yasushi |
author_sort | Sunaga, Akihiro |
collection | PubMed |
description | Background: Anticoagulation for patients with atrial fibrillation (AF) complicated by left atrial thrombi (LAT) is a frequent cause of bleeding complications, but risk factors remain unknown. Methods and Results: Of 3,139 AF patients who underwent transesophageal echocardiography, 82 with LAT under anticoagulation were included in this study. Patients treated with combination antiplatelet and anticoagulant therapy (n=31) were compared with those receiving anticoagulant monotherapy (n=51) to investigate the effects of antiplatelet agents during anticoagulation on bleeding complications. Over a mean (±SD) follow-up of 878±486 days, bleeding events occurred more frequently in the combination therapy than monotherapy group (58% vs. 20%; P<0.001), but there was no significant difference in embolic events (6.5% vs. 3.9%; P=0.606). Kaplan-Meier analysis also showed a significantly higher rate of bleeding events in the combination therapy group, but no significant difference in the rate of embolic events. Inverse probability of treatment weighting revealed that combination therapy was independently associated with an increased risk of bleeding (hazard ratio [HR] 2.98, 95% confidence interval [CI] 1.14–7.89, P=0.026), but not with the risk of embolic events (HR 0.30, 95% CI 0.04–2.59, P=0.275). Net clinical benefit analysis was almost negative for combination therapy vs. monotherapy. Conclusions: In patients with AF and LAT, combination therapy was significantly associated with an increased risk of bleeding events, but not with a reduced risk of embolic events. |
format | Online Article Text |
id | pubmed-7819665 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | The Japanese Circulation Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-78196652021-03-09 Comparison of Long-Term Outcomes Between Combination Antiplatelet and Anticoagulant Therapy and Anticoagulant Monotherapy in Patients With Atrial Fibrillation and Left Atrial Thrombi Sunaga, Akihiro Hikoso, Shungo Nakatani, Daisaku Inoue, Koichi Okuyama, Yuji Egami, Yasuyuki Kashiwase, Kazunori Hirata, Akio Masuda, Masaharu Furukawa, Yoshio Watanabe, Tetsuya Mizuno, Hiroya Okada, Katsuki Dohi, Tomoharu Kitamura, Tetsuhisa Komukai, Sho Kurakami, Hiroyuki Yamada, Tomomi Takeda, Toshihiro Kida, Hirota Oeun, Bolrathanak Kojima, Takayuki Minamiguchi, Hitoshi Sakata, Yasushi Circ Rep Original article Background: Anticoagulation for patients with atrial fibrillation (AF) complicated by left atrial thrombi (LAT) is a frequent cause of bleeding complications, but risk factors remain unknown. Methods and Results: Of 3,139 AF patients who underwent transesophageal echocardiography, 82 with LAT under anticoagulation were included in this study. Patients treated with combination antiplatelet and anticoagulant therapy (n=31) were compared with those receiving anticoagulant monotherapy (n=51) to investigate the effects of antiplatelet agents during anticoagulation on bleeding complications. Over a mean (±SD) follow-up of 878±486 days, bleeding events occurred more frequently in the combination therapy than monotherapy group (58% vs. 20%; P<0.001), but there was no significant difference in embolic events (6.5% vs. 3.9%; P=0.606). Kaplan-Meier analysis also showed a significantly higher rate of bleeding events in the combination therapy group, but no significant difference in the rate of embolic events. Inverse probability of treatment weighting revealed that combination therapy was independently associated with an increased risk of bleeding (hazard ratio [HR] 2.98, 95% confidence interval [CI] 1.14–7.89, P=0.026), but not with the risk of embolic events (HR 0.30, 95% CI 0.04–2.59, P=0.275). Net clinical benefit analysis was almost negative for combination therapy vs. monotherapy. Conclusions: In patients with AF and LAT, combination therapy was significantly associated with an increased risk of bleeding events, but not with a reduced risk of embolic events. The Japanese Circulation Society 2020-07-30 /pmc/articles/PMC7819665/ /pubmed/33693270 http://dx.doi.org/10.1253/circrep.CR-20-0036 Text en Copyright © 2020, THE JAPANESE CIRCULATION SOCIETY This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license.https://creativecommons.org/licenses/by-nc-nd/4.0/ |
spellingShingle | Original article Sunaga, Akihiro Hikoso, Shungo Nakatani, Daisaku Inoue, Koichi Okuyama, Yuji Egami, Yasuyuki Kashiwase, Kazunori Hirata, Akio Masuda, Masaharu Furukawa, Yoshio Watanabe, Tetsuya Mizuno, Hiroya Okada, Katsuki Dohi, Tomoharu Kitamura, Tetsuhisa Komukai, Sho Kurakami, Hiroyuki Yamada, Tomomi Takeda, Toshihiro Kida, Hirota Oeun, Bolrathanak Kojima, Takayuki Minamiguchi, Hitoshi Sakata, Yasushi Comparison of Long-Term Outcomes Between Combination Antiplatelet and Anticoagulant Therapy and Anticoagulant Monotherapy in Patients With Atrial Fibrillation and Left Atrial Thrombi |
title | Comparison of Long-Term Outcomes Between Combination Antiplatelet and Anticoagulant Therapy and Anticoagulant Monotherapy in Patients With Atrial Fibrillation and Left Atrial Thrombi |
title_full | Comparison of Long-Term Outcomes Between Combination Antiplatelet and Anticoagulant Therapy and Anticoagulant Monotherapy in Patients With Atrial Fibrillation and Left Atrial Thrombi |
title_fullStr | Comparison of Long-Term Outcomes Between Combination Antiplatelet and Anticoagulant Therapy and Anticoagulant Monotherapy in Patients With Atrial Fibrillation and Left Atrial Thrombi |
title_full_unstemmed | Comparison of Long-Term Outcomes Between Combination Antiplatelet and Anticoagulant Therapy and Anticoagulant Monotherapy in Patients With Atrial Fibrillation and Left Atrial Thrombi |
title_short | Comparison of Long-Term Outcomes Between Combination Antiplatelet and Anticoagulant Therapy and Anticoagulant Monotherapy in Patients With Atrial Fibrillation and Left Atrial Thrombi |
title_sort | comparison of long-term outcomes between combination antiplatelet and anticoagulant therapy and anticoagulant monotherapy in patients with atrial fibrillation and left atrial thrombi |
topic | Original article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819665/ https://www.ncbi.nlm.nih.gov/pubmed/33693270 http://dx.doi.org/10.1253/circrep.CR-20-0036 |
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