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Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy.
Tzoran, Inna; Brenner, Benjamin; Sakharov, Gleb; Trujillo-Santos, Javier; Lorenzo, Alicia; Madridano, Olga; López-Sáez, Juan Bosco; Monreal, Manuel.
Afiliación
  • Tzoran I; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Israel. Electronic address: i_tzoran@rambam.health.gov.il.
  • Brenner B; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
  • Sakharov G; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Israel.
  • Trujillo-Santos J; Department of Internal Medicine, Hospital Universitario de Santa Lucía, Cartagena, Spain.
  • Lorenzo A; Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain.
  • Madridano O; Department of Internal Medicine, Hospital Infanta Sofía, Madrid, Spain.
  • López-Sáez JB; Department of Internal Medicine, Hospital Universitario Puerto Real, Cádiz, Spain.
  • Monreal M; Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain.
Eur J Intern Med ; 25(9): 821-5, 2014 Nov.
Article en En | MEDLINE | ID: mdl-25287697
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inhibidores de Agregación Plaquetaria / Tromboembolia Venosa / Anticoagulantes Tipo de estudio: Prognostic_studies Límite: Aged / Female / Humans / Male Idioma: En Revista: Eur J Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2014 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inhibidores de Agregación Plaquetaria / Tromboembolia Venosa / Anticoagulantes Tipo de estudio: Prognostic_studies Límite: Aged / Female / Humans / Male Idioma: En Revista: Eur J Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2014 Tipo del documento: Article Pais de publicación: Países Bajos