| Summary: | Background: The use of non-vitamin K antagonist oral anticoagulants (NOACs) in
patients with non-valvular atrial fibrillation (AF) has been increasing.
Accordingly, the combined use of antiplatelet agents (APT) and NOAC therapy is
commonly encountered in clinical practice. The purpose of this study was to
compare the clinical outcomes between combination therapy (NOAC and APT) vs.
monotherapy (NOAC only) in patients with AF. Methods: We retrospectively analyzed
patients who were prescribed NOACs between January 2012 and December 2016. The
primary outcome was major bleeding and any bleeding events, and the secondary
outcomes were stroke/systemic embolic (SE) events and major adverse cardiac
events (MACE). Results: Of the 1068 participants, there were 264 (24.7%)
patients in the combination therapy group. The prevalence of diabetes (p = 0.017)
and history of stroke and transient ischemic attacks (p <
0.001) was higher in the combination group than in the monotherapy group. During
the mean 14.6 ± 9.8 months of follow-up, the incidence of any bleeding was
significantly higher in the combination therapy group than in the monotherapy
group (p < 0.001). The rate of major bleeding, stroke/SE, and MACE
between the two groups was similar. The rate of under-dosage NOAC prescriptions
was higher in the combination therapy group than in the monotherapy group
(p = 0.024). Conclusions: The combination therapy group had higher
incidences of any bleeding events compared to the monotherapy in patients with
appropriate dosing. However, there was no difference in stroke/SE, and MACE. The
bleeding risk in AF patients taking the combination of NOACs and APT should be
carefully evaluated.
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