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Concomitant antiplatelet agents increased bleeding events in atrial fibrillation/vascular disease patients

Lankenau Medical Center May 30, 2019 Research News

While most patients diagnosed with a combination of atrial fibrillation (AF) and vascular disease are treated with oral anticoagulants, concomitant antiplatelet therapy for various indications also may be administered. However, combination therapy is associated with increased risk for bleeding and may not be associated with improved cardiovascular outcomes depending on the indication, according to the results of a nationwide study in which Main Line Health participated.

Researchers analyzed treatments and outcomes in 1,920 patients diagnosed with both new-onset AF and vascular disease who were part of the ORBIT-AF II patient registry, a Duke University initiative funded by a grant from Johnson & Johnson. Main Line Health’s Peter Kowey, MD, and Michael Ezekowitz, DPhil, were members of the steering committee for this registry that has enrolled more than 20,000 patients who were diagnosed with AF and are receiving an anticoagulant drug.

When looking at treatment outcomes, the researchers found that patients with AF and vascular disease do indeed have an increased risk for major adverse cardiovascular and neurological events (MACNE). Consequently, most of the patients in this cohort were treated with oral anticoagulants, either a direct-acting anticoagulant (DOAC) or vitamin K antagonist.

About half of the patients in this cohort also were being treated with concomitant antiplatelet therapy. Although some had reason to take antiplatelet drugs, many did not. That percentage has been increasing in recent years, even though this treatment approach is inconsistent with consensus recommendations in terms of indication and duration, noted the researchers.

“The most significant finding of our study was that treatment with both DOACs and antiplatelet therapy led to more bleeding events in this subset of patients,” noted Kowey, chairman emeritus of cardiology at Lankenau Heart Institute, professor at the Lankenau Institute for Medical Research, and one of the study’s authors. “Compounding this dilemma, we did not see any definitive improvements in MACNE in these patients, so we are cautioning clinicians to reconsider concomitant use of antiplatelet agents in these cases. Specifically, when seeing an anticoagulated patient who is also on aspirin and/or a thienopyridine, ask the question: ‘Does my patient need all of these drugs, and if so, when can any of them be stopped?’”

Dr. Kowey and his coauthors called for further studies to clarify the optimal management of this specific high-risk population.

The study’s results were published in the manuscript “Treatment of Atrial Fibrillation with Concomitant Coronary or Peripheral Artery Disease: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II” in American Heart Journal. View the full manuscript is available at sciencedirect.com.

About Main Line Health

Founded in 1985,Main Line Health is a not-for-profit health system serving portions of Philadelphia and its western suburbs. Main Line Health’s commitment—to deliver advanced medicine to treat and cure disease while also playing an important role in prevention and disease management as well as training physicians and other health care providers—reflects our intent to keep our community and ourselves well ahead. A team of more than 10,000 employees and 2,000 physicians care for patients throughout the Main Line Health system.

At Main Line Health’s core are four of the region’s most respected acute care hospitals—Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital—as well as one of the nation’s recognized facilities for rehabilitative medicine, Bryn Mawr Rehabilitation Hospital.

Main Line Health also includes Mirmont Treatment Center for drug and alcohol recovery; Main Line Health HomeCare & Hospice, which includes skilled home health care, hospice and home infusion services; Main Line Health Centers, primary and specialty care, lab and radiology, and other outpatient services located in Broomall, Collegeville, Concordville, Exton, King of Prussia and Newtown Square; Lankenau Institute for Medical Research, a biomedical research organization; and Main Line HealthCare,one of the region’s largest multispecialty physician networks.

Main Line Health is the recipient of numerous awards for quality care and service, including System Magnet® designation, the nation’s highest distinction for nursing excellence and the Mid-Atlantic Alliance for Performance Excellence (MAAPE) Excellence Award. Main Line Health is committed to creating an environment of diversity, respect and inclusion and has proudly embraced the American Hospital Association’s #123forEquity Pledge to Act to eliminate disparities in care. We are dedicated to advancing patient-centered care, education and research to help our community stay healthy.

About Lankenau Institute for Medical Research

Lankenau Institute for Medical Research (LIMR) is a nonprofit biomedical research institute located on the campus of Lankenau Medical Center and is part of Main Line Health. Founded in 1927, LIMR’s mission is to improve human health and well-being. Faculty and staff are devoted to advancing innovative new approaches to formidable medical challenges, including cancer, cardiovascular disease, gastrointestinal disorders and autoimmune diseases, such as diabetes and arthritis. LIMR’s principal investigators conduct basic, preclinical and translational research, using their findings to explore ways to improve disease detection, diagnosis, treatment and prevention. They are committed to extending the boundaries of human health through technology transfer and training of the next generation of scientists and physicians.