Bleeding risks associated with anticoagulant therapies after percutaneous coronary intervention in Japanese patients with ischemic heart disease complicated by atrial fibrillation: A comparative study
| Autor: | Akiko Hayakawa, Hirokazu Tanabe, Kazuhiro Uchino, Takeshi Yamashita, Toru Sekine, Takuyuki Matsumoto, Masato Nakamura, Tomoko Iizuka, Chie Hasegawa, Seiji Kogure, Atsushi Takita |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Lower gastrointestinal bleeding medicine.drug_class medicine.medical_treatment Population Myocardial Ischemia Administration Oral Hemorrhage 030204 cardiovascular system & hematology Lower risk 03 medical and health sciences Percutaneous Coronary Intervention Postoperative Complications 0302 clinical medicine Japan Risk Factors Internal medicine Atrial Fibrillation medicine Humans Postoperative Period 030212 general & internal medicine education Aged Retrospective Studies education.field_of_study business.industry Incidence Anticoagulant Anticoagulants Percutaneous coronary intervention Atrial fibrillation Middle Aged medicine.disease Conventional PCI Cardiology Female Cardiology and Cardiovascular Medicine business Cohort study |
| Zdroj: | Journal of Cardiology. 77:186-194 |
| ISSN: | 0914-5087 |
| Popis: | Background Current guidelines recommend early termination of triple therapy and the use of direct oral anticoagulants (DOAC) for non-valvular atrial fibrillation (NVAF) patients who undergo percutaneous coronary intervention (PCI), due to safety concerns. However, to date, real-world medication usage and safety outcomes (specifically bleeding) in NVAF patients with stent implantation have not been well assessed. Methods This was a retrospective, observational, medical database cohort study in Japanese ischemic heart disease (IHD) patients with NVAF who underwent PCI between 2012 and 2017. The primary outcome was clinically relevant bleeding; secondary outcomes included individual bleeding events. A multivariate analysis was conducted to identify risk factors affecting the occurrence of clinically relevant bleeding events. Results The analysis population comprised 5695 patients [3530 received DOACs and 2165 received vitamin K antagonists (VKAs)]. The incidence of primary outcome events (clinically relevant bleeding/100 patient-years) was 6.05 in the DOAC group and 8.42 in the VKA group, resulting in a nonsignificant 21% lower risk in the DOAC group. The DOAC group also had a nonsignificant 24%, 24%, and 34% lower risk of bleeding requiring transfusion, intracranial bleeding, and lower gastrointestinal bleeding, respectively, compared with the VKA group. A multivariate analysis of the primary outcome showed a significantly higher risk of bleeding among older patients and those with lower body weight and abnormal renal function. Conclusions In this retrospective real-world evaluation of IHD patients with NVAF and PCI, DOAC-treated patients had a lower risk of developing clinically relevant bleeding compared with the VKA group. |
| Databáze: | OpenAIRE |
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