Biomaterial Database

Comparison of Long-Term Outcomes Between Combination Antiplatelet and Anticoagulant Therapy and Anticoagulant Monotherapy in Patients With Atrial Fibrillation and Left Atrial Thrombi. 2020

Akihiro Sunaga, and Shungo Hikoso, and Daisaku Nakatani, and Koichi Inoue, and Yuji Okuyama, and Yasuyuki Egami, and Kazunori Kashiwase, and Akio Hirata, and Masaharu Masuda, and Yoshio Furukawa, and Tetsuya Watanabe, and Hiroya Mizuno, and Katsuki Okada, and Tomoharu Dohi, and Tetsuhisa Kitamura, and Sho Komukai, and Hiroyuki Kurakami, and Tomomi Yamada, and Toshihiro Takeda, and Hirota Kida, and Bolrathanak Oeun, and Takayuki Kojima, and Hitoshi Minamiguchi, and Yasushi Sakata, and

Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan.

Anticoagulation for patients with atrial fibrillation (AF) complicated by left atrial thrombi (LAT) is a frequent cause of bleeding complications, but risk factors remain unknown. Of 3,139 AF patients who underwent transesophageal echocardiography, 82 with LAT under anticoagulation were included in this study. Patients treated with combination antiplatelet and anticoagulant therapy (n=31) were compared with those receiving anticoagulant monotherapy (n=51) to investigate the effects of antiplatelet agents during anticoagulation on bleeding complications. Over a mean (±SD) follow-up of 878±486 days, bleeding events occurred more frequently in the combination therapy than monotherapy group (58% vs. 20%; P<0.001), but there was no significant difference in embolic events (6.5% vs. 3.9%; P=0.606). Kaplan-Meier analysis also showed a significantly higher rate of bleeding events in the combination therapy group, but no significant difference in the rate of embolic events. Inverse probability of treatment weighting revealed that combination therapy was independently associated with an increased risk of bleeding (hazard ratio [HR] 2.98, 95% confidence interval [CI] 1.14-7.89, P=0.026), but not with the risk of embolic events (HR 0.30, 95% CI 0.04-2.59, P=0.275). Net clinical benefit analysis was almost negative for combination therapy vs. monotherapy. In patients with AF and LAT, combination therapy was significantly associated with an increased risk of bleeding events, but not with a reduced risk of embolic events.