Concomitant use of warfarin and ticagrelor as an alternative to triple antithrombotic therapy after an acute coronary syndrome. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Braun, Oscar Ö.; Bico, Besim; Chaudhry, Uzma; Wagner, Henrik; Koul, Sasha; Tydén, Patrik; Scherstén, Fredrik; Jovinge, Stefan; Svensson, Peter J.; Gustav Smith, J.; van der Pals, Jesper
• Is Part Of: Thrombosis research. Volume 135:Issue 1(2015)
• Page Start: 26
• Page End: 30
• Publication Date: 2015-01
• Subjects: Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2014.10.016
• Languages: English
• ISSNs: 0049-3848

Abstract

<abstract abstract-type="author" id="ab0005"> <title id="st0005">Abstract</title> <sec> <title id="st0010">Introduction</title> <p id="sp0005">Treatment with warfarin in combination with clopidogrel has been shown to reduce the incidence of major bleeding as compared to triple antithrombotic therapy (TT; warfarin, clopidogrel and aspirin). However, there are uncertainties regarding the risk for thrombosis since poor-responsiveness to clopidogrel is common. Ticagrelor is a more potent platelet inhibitor, but data supporting concurrent use of ticagrelor and warfarin (dual antithrombotic therapy, DT) is limited. This study therefore sought to evaluate the risk of bleeding and thrombosis associated with DT after an acute coronary syndrome (ACS).</p> </sec> <sec> <title id="st0015">Materials and methods</title> <p id="sp0010">We identified all ACS patients on DT upon discharge from Helsingborg Hospital and Skåne University Hospital in Malmö and Lund, Sweden, during 2013. Patients on DT were compared with historical controls discharged with TT. Major bleeding was defined in accordance with the HAS-BLED derivation study. Patients were retrospectively followed for three months.</p> </sec> <sec> <title id="st0020">Results</title> <p id="sp0015">In total, 107 DT patients were identified and compared with 159 controls on TT. Mean HAS-BLED bleeding risk score and duration of treatment were similar between the groups (HAS-BLED 2.2 +/− 0.8 vs 2.2 +/− 1.0 units, p = NS; duration 2.7 +/− 0.8 vs 2.5 +/− 0.9 months, p = NS; DT vs TT). The incidence of spontaneous major bleeding was similar between the groups, as was a composite of all thrombotic events, i.e. peripheral embolism, stroke/TIA and acute coronary syndrome (bleeding 8/106 (7.5%) vs 11/157 (7.0%), p = NS; thrombosis 5/106 (4.7%) vs 5/157 (3.2%), p = NS; DT vs TT).</p> </sec> <sec> <title id="st0025">Conclusions</title> <p id="sp0020">Rates of thrombotic and bleeding events were similar in patients with TT and patients with ticagrelor and warfarin.</p> </sec> </abstract>