Triple Anticoagulation Therapy Raises Bleeding Risk in Elderly Patients with AFib and Heart Attack

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Connie N. Hess, MD, MHS Duke Clinical Research Institute Duke University Durham, North CarolinaMedicalResearch.com Interview with:
Connie N. Hess, MD, MHS
Duke Clinical Research Institute
Duke University
Durham, North Carolina

Medical Research: What is the background for this study? What are the main findings?

Dr. Hess: Guidelines recommend the use of anticoagulation for thromboembolic prophylaxis in atrial fibrillation and also recommend use of dual antiplatelet therapy to reduce cardiovascular events after myocardial infarction and percutaneous coronary intervention.  The use of triple therapy in patients with indications for DAPT and anticoagulation is challenging due to the increased bleeding risk associated with this regimen.  The optimal antithrombotic regimen in this population has not yet been defined.

This study specifically focused on older patients, a population that is at greater risk for Atrial Fibrillation-related stroke and recurrent events after MI but also higher risk for bleeding. Despite a growing population of older patients with indications for triple therapy, these patients have been underrepresented in clinical trials and are therefore understudied.

We found that relative to DAPT, patients on triple therapy had a similar risk of 2-year major adverse cardiac events but a significantly increased risk of bleeding requiring hospitalization, including greater risk of intracranial hemorrhage.

Medical Research: What should clinicians and patients take away from your report?

Dr. Hess: These data suggest that the risk-benefit ratio of triple therapy in older patients with myocardial infarction and Atrial Fibrillation should be carefully considered, as we found a significant increase in bleeding associated with triple therapy use without any associated reduction in MACE.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Hess: Our results need to be confirmed with prospective studies focused on older patients with Atrial Fibrillation and MI; a number of ongoing randomized clinical trials may help to provide insight.

Citation:

Hess CN, Peterson ED, Peng S, et al. Use and Outcomes of Triple Therapy Among Older Patients With Acute Myocardial Infarction and Atrial Fibrillation. J Am Coll Cardiol. 2015;66(6):616-627. doi:10.1016/j.jacc.2015.05.062.

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Connie N. Hess, MD, MHS (2015). Triple Anticoagulation Therapy Raises Bleeding Risk in Elderly Patients with AFib and Heart Attack 

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