Triple vs Dual Antithrombotic Therapy in Patients with Atrial Fibrillation and Coronary Artery Disease

Renato D. Lopes, Meena Rao, Dajuanicia N. Simon, Laine Thomas, Jack Ansell, Gregg C. Fonarow, Bernard J. Gersh, Alan S. Go, Elaine M. Hylek, Peter Kowey, Jonathan P. Piccini, Daniel E. Singer, Paul Chang, Eric D. Peterson, Kenneth W. Mahaffey

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Background The role of triple antithrombotic therapy vs dual antithrombotic therapy in patients with both atrial fibrillation and coronary artery disease remains unclear. This study explores the differences in treatment practices and outcomes between triple antithrombotic therapy and dual antithrombotic therapy in patients with atrial fibrillation and coronary artery disease. Methods Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (n = 10,135), we analyzed outcomes in patients with coronary artery disease (n = 1827) according to treatment with triple antithrombotic therapy (defined as concurrent therapy with an oral anticoagulant, a thienopyridine, and aspirin) or dual antithrombotic therapy (comprising either an oral anticoagulant and one antiplatelet agent [OAC plus AA] or 2 antiplatelet drugs and no anticoagulant [DAP]). Results The use of triple antithrombotic therapy, OAC plus AA, and DAP at baseline was 8.5% (n = 155), 80.4% (n = 1468), and 11.2% (n = 204), respectively. Among patients treated with OAC plus AA, aspirin was the most common antiplatelet agent used (90%), followed by clopidogrel (10%) and prasugrel (0.1%). The use of triple antithrombotic therapy was not affected by patient risk of either stroke or bleeding. Patients treated with triple antithrombotic therapy at baseline were hospitalized for all causes (including cardiovascular) more often than patients on OAC plus AA (adjusted hazard ratio 1.75; 95% confidence interval, 1.35-2.26; P <.0001) or DAP (hazard ratio 1.82; 95% confidence interval, 1.25-2.65; P =.0018). Rates of major bleeding or a combined cardiovascular outcome were not significantly different by treatment group. Conclusions Choice of antithrombotic therapy in patients with atrial fibrillation and coronary artery disease was not affected by patient stroke or bleeding risks. Triple antithrombotic therapy-treated patients were more likely to be hospitalized for all causes than those on OAC plus AA or on DAP.

Original languageEnglish (US)
Pages (from-to)592-599.e1
JournalAmerican Journal of Medicine
Volume129
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Keywords

  • Anticoagulants
  • Antiplatelets
  • Atrial fibrillation
  • Combined therapy
  • Coronary artery disease

ASJC Scopus subject areas

  • Medicine(all)

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