Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy.
Details
Serval ID
serval:BIB_D6816FBC4487
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy.
Journal
European Journal of Internal Medicine
Working group(s)
RIETE investigators
Contributor(s)
Andújar V., Arcelus JI., Auguet T., Barba R., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Bueso T., Casado I., Casillas C., Conget F., del Molino F., del Toro J., Falgá C., Fernández-Capitán C., Font L., Gallego P., García-Bragado F., Gómez V., González J., González-Bachs E., Guijarro R., Guil M., Gutiérrez J., Hernández L., Hernández-Huerta S., Jara-Palomares L., Jaras MJ., Jiménez D., Jiménez R., Lobo JL., López-Jiménez L., López-Montes L., López-Reyes R., López-Sáez JB., Lorente MA., Lorenzo A., Luque MJ., Llutart J., Madridano O., Marchena PJ., Martín M., Martín-Antorán JM., Mellado M., Monreal M., Nauffal D., Nieto JA., Ogea JL., Otero R., Pagán B., Pedrajas JM., Peris ML., Porras JA., Pons I., Riera-Mestre A., Rivas A., Rodríguez-Dávila MA., Román P., Roncero A., Rosa V., Ruiz-Giménez N., Ruiz J., Sabio P., Sahuquillo JC., Samperiz A., Sánchez R., Sánchez Muñoz-Torrero JF. , Soler S., Suriñach JM., Tiberio G., Tirado R., Tolosa C., Trujillo-Santos J., Valero B., Valle R., Vela J., Vidal G., Villalobos A., Vilella V., Malfante P., Villagra M., Vivero F., Verhamme P., Peerlinck K., Malý R., Hirmerova J., Kaletova M., Bertoletti L., Bura-Riviere A., Farge-Bancel D., Grange C., Hij A., Mahe I., Merah A., Quere I., Schellong S., Babalis D., Papadakis M., Tzinieris I., Braester A., Brenner B., Tzoran I., Zeltser D., Apollonio A., Barillari G., Ciammaichella M., Di Micco P., Duce R., Guida A., Maida R., Mattei L., Pace F., Piovella C., Pesavento R., Poggio R., Prandoni P., Rota L., Schenone A., Tonello D., Tufano A., Visonà A., Zalunardo B., Santos M., Bosevski M., Kovacevic D., Alatri A., Bounameaux H., Calanca L., Mazzolai L., Serrano JC.
ISSN
1879-0828 (Electronic)
ISSN-L
0953-6205
Publication state
Published
Issued date
2014
Peer-reviewed
Oui
Volume
25
Number
9
Pages
821-825
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Abstract
INTRODUCTION: Patients with arterial disease receiving antiplatelet agents may develop venous thromboembolism (VTE) and need anticoagulant therapy, although concomitant use of these drugs may increase bleeding risk. We analyzed RIETE data and compared clinical outcomes depending on decision to discontinue or maintain antiplatelet therapy at VTE diagnosis.
METHODS: Consecutive patients with acute VTE were enrolled in RIETE. Only patients receiving antiplatelet therapy at baseline were included in this analysis. Primary outcomes were: rate of subsequent ischemic events, major bleeding or death during anticoagulation course.
RESULTS: 1178 patients who received antiplatelet drugs at VTE diagnosis were included. Antiplatelet therapy was discontinued in 62% of patients. During anticoagulation course, patients also receiving antiplatelet therapy had higher rates of lower limb amputations (2.28 vs. 0.21 events per 100 patients-years; p<0.01), any ischemic events (5.7 vs. 2.28 events per 100 patients-years; p<0.05) or death (23.6 vs. 13.9 deaths per 100 patients-years; p<0.01). No differences in the rate of major bleeding or recurrent VTE were revealed. In matched analysis, patients on antiplatelet therapy were found to have a significantly higher rate of limb amputations (odds ratio: 15.3; 95% CI: 1.02-229) and an increased number of composite outcomes including all-cause deaths, arterial and VTE events (odds ratio: 1.46; CI: 1.03-2.06), with no differences in major bleeding rate.
CONCLUSION: Concomitant anticoagulant and antiplatelet therapy in patients with VTE and arterial disease is not associated with increased risk for bleeding, recurrent VTE or death. The worse outcome observed in patients who continued antiplatelet therapy requires further investigations.
METHODS: Consecutive patients with acute VTE were enrolled in RIETE. Only patients receiving antiplatelet therapy at baseline were included in this analysis. Primary outcomes were: rate of subsequent ischemic events, major bleeding or death during anticoagulation course.
RESULTS: 1178 patients who received antiplatelet drugs at VTE diagnosis were included. Antiplatelet therapy was discontinued in 62% of patients. During anticoagulation course, patients also receiving antiplatelet therapy had higher rates of lower limb amputations (2.28 vs. 0.21 events per 100 patients-years; p<0.01), any ischemic events (5.7 vs. 2.28 events per 100 patients-years; p<0.05) or death (23.6 vs. 13.9 deaths per 100 patients-years; p<0.01). No differences in the rate of major bleeding or recurrent VTE were revealed. In matched analysis, patients on antiplatelet therapy were found to have a significantly higher rate of limb amputations (odds ratio: 15.3; 95% CI: 1.02-229) and an increased number of composite outcomes including all-cause deaths, arterial and VTE events (odds ratio: 1.46; CI: 1.03-2.06), with no differences in major bleeding rate.
CONCLUSION: Concomitant anticoagulant and antiplatelet therapy in patients with VTE and arterial disease is not associated with increased risk for bleeding, recurrent VTE or death. The worse outcome observed in patients who continued antiplatelet therapy requires further investigations.
Pubmed
Web of science
Create date
20/02/2015 10:35
Last modification date
02/06/2020 14:09
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