Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Characteristics and outcomes in patients with atrial fibrillation and acute coronary syndrome treated with ticagrelor and novel oral anticoagulants

van der Pals, Jesper LU ; Holmqvist, Fredrik LU ; Borgquist, Rasmus LU orcid ; Götberg, Matthias LU ; Nseir, Mohaned ; Koul, Sasha LU ; Isma, Nazim LU ; Scherstén, Fredrik LU ; Tydén, Patrik LU and Braun, Oscar LU , et al. (2021) In Thrombosis Update 3.
Abstract

Introduction: Optimal antithrombotic treatment after an acute coronary syndrome (ACS) in patients with atrial fibrillation is unclear. Data on outcomes in patients on concomitant ticagrelor and the novel oral anticoagulants (NOAC) is scarce. This study therefore sought to describe patient characteristics and treatment outcomes in patients with atrial fibrillation and ACS treated with concomitant ticagrelor and NOACs (double antithrombotic therapy, DT). Materials and methods: We retrospectively identified all ACS patients with atrial fibrillation on DT upon discharge from Skåne University Hospital in Lund, Sweden, between 2016 and 2019. Identified patients were compared with age and sex matched controls with ACS alone treated with... (More)

Introduction: Optimal antithrombotic treatment after an acute coronary syndrome (ACS) in patients with atrial fibrillation is unclear. Data on outcomes in patients on concomitant ticagrelor and the novel oral anticoagulants (NOAC) is scarce. This study therefore sought to describe patient characteristics and treatment outcomes in patients with atrial fibrillation and ACS treated with concomitant ticagrelor and NOACs (double antithrombotic therapy, DT). Materials and methods: We retrospectively identified all ACS patients with atrial fibrillation on DT upon discharge from Skåne University Hospital in Lund, Sweden, between 2016 and 2019. Identified patients were compared with age and sex matched controls with ACS alone treated with ticagrelor and aspirin (DAPT). Major bleeding was defined in accordance with the HAS-BLED derivation study. Patients were retrospectively followed for six months. Results: In total, 341 patients on DT were identified and compared with 341 controls on DAPT. Mean HAS-BLED bleeding risk score was higher in patients on DT (2.9 ± 1.0 vs 2.6+/0.9 units, p < 0.001; DT vs DAPT). The incidence of major bleeding was higher in patients on DT (31 (9.1%) vs 10 (2.9%), p = 0.001; DT vs DAPT), while a composite of all thrombotic events was found to be similar between the groups (8 (2.3%) vs 5 (1.5%), p = NS; DT vs DAPT). Conclusions: While thrombotic events occur at a similar rate, the bleeding rate is higher in patients with atrial fibrillation and ACS treated with DT than in patients with ACS alone treated with DAPT. Patients with atrial fibrillation also have a higher basal bleeding risk.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute coronary syndrome, Antithrombotic therapy, Novel oral anticoagulants, Ticagrelor
in
Thrombosis Update
volume
3
article number
100054
pages
5 pages
publisher
Elsevier
external identifiers
  • scopus:85126091937
DOI
10.1016/j.tru.2021.100054
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2021 The Authors
id
c58e0602-dda7-4d9e-8154-4d738fb4555d
date added to LUP
2022-05-18 10:31:17
date last changed
2022-06-08 01:02:54
@article{c58e0602-dda7-4d9e-8154-4d738fb4555d,
  abstract     = {{<p>Introduction: Optimal antithrombotic treatment after an acute coronary syndrome (ACS) in patients with atrial fibrillation is unclear. Data on outcomes in patients on concomitant ticagrelor and the novel oral anticoagulants (NOAC) is scarce. This study therefore sought to describe patient characteristics and treatment outcomes in patients with atrial fibrillation and ACS treated with concomitant ticagrelor and NOACs (double antithrombotic therapy, DT). Materials and methods: We retrospectively identified all ACS patients with atrial fibrillation on DT upon discharge from Skåne University Hospital in Lund, Sweden, between 2016 and 2019. Identified patients were compared with age and sex matched controls with ACS alone treated with ticagrelor and aspirin (DAPT). Major bleeding was defined in accordance with the HAS-BLED derivation study. Patients were retrospectively followed for six months. Results: In total, 341 patients on DT were identified and compared with 341 controls on DAPT. Mean HAS-BLED bleeding risk score was higher in patients on DT (2.9 ± 1.0 vs 2.6+/0.9 units, p &lt; 0.001; DT vs DAPT). The incidence of major bleeding was higher in patients on DT (31 (9.1%) vs 10 (2.9%), p = 0.001; DT vs DAPT), while a composite of all thrombotic events was found to be similar between the groups (8 (2.3%) vs 5 (1.5%), p = NS; DT vs DAPT). Conclusions: While thrombotic events occur at a similar rate, the bleeding rate is higher in patients with atrial fibrillation and ACS treated with DT than in patients with ACS alone treated with DAPT. Patients with atrial fibrillation also have a higher basal bleeding risk.</p>}},
  author       = {{van der Pals, Jesper and Holmqvist, Fredrik and Borgquist, Rasmus and Götberg, Matthias and Nseir, Mohaned and Koul, Sasha and Isma, Nazim and Scherstén, Fredrik and Tydén, Patrik and Braun, Oscar and Erlinge, David}},
  keywords     = {{Acute coronary syndrome; Antithrombotic therapy; Novel oral anticoagulants; Ticagrelor}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Thrombosis Update}},
  title        = {{Characteristics and outcomes in patients with atrial fibrillation and acute coronary syndrome treated with ticagrelor and novel oral anticoagulants}},
  url          = {{http://dx.doi.org/10.1016/j.tru.2021.100054}},
  doi          = {{10.1016/j.tru.2021.100054}},
  volume       = {{3}},
  year         = {{2021}},
}