EP News: Clinical

  • N.A. Mark Estes III
    Address reprint requests and correspondence: Dr N.A. Mark Estes III, UPMC Heart and Vascular Institute, Presbyterian Hospital, 200 Lothrop St, 3rd Floor South Tower (WE352.1), Pittsburgh, PA 15213.
    UPMC Heart and Vascular Institute, Presbyterian Hospital, Pittsburgh, Pennsylvania
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      van Rein et al (Circulation 2019;139:775, PMID 30586754) evaluated bleeding rates in a comprehensive national database of patients with atrial fibrillation (AF) who were 50 years and older. Treatments included vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs), platelet inhibitors, and combinations of antithrombotic drugs. Major bleeding was defined as bleeding requiring hospitalization or causing death. Overall, 272,315 patients with AF were followed for 1,373,131 patient-years (PYs); 31,459 major bleeds occurred for an incidence rate (IR) of 2.3 per 100 PYs. Compared with VKA monotherapy, the hazard ratio for major bleeding was 1.13 for dual antiplatelet therapy, 1.82 for therapy with a VKA and an antiplatelet drug, 1.28 for DOAC therapy with an antiplatelet drug, 3.73 for VKA triple therapy, and 2.28 for DOAC triple therapy. The IR for major bleeding was 10.2 per 100 PYs in patients on triple therapy. Very high major bleeding rates were found in patients on triple therapy who were older than 90 years (IR 22.8 per 100 PYs) or with a CHA2DS2-VASc score of >6 (IR 17.6 per 100 PYs) or with a history of major bleeding (IR 17.5 per 100 PYs). The authors conclude that patients with AF on triple therapy experienced high rates of major bleeding in comparison with patients receiving dual therapy or monotherapy.
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