Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy |
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| Institution: | 1. Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Israel;2. Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel;3. Department of Internal Medicine, Hospital Universitario de Santa Lucía, Cartagena, Spain;4. Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain;5. Department of Internal Medicine, Hospital Infanta Sofía, Madrid, Spain;6. Department of Internal Medicine, Hospital Universitario Puerto Real, Cádiz, Spain;7. Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain;1. Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, China;2. Department of Infectious Diseases, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China;3. People''s Hospital of District of YuBei, Chongqing, China;1. School of Medical Sciences, Bangor University, Bangor, United Kingdom;2. Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, United Kingdom;3. NWORTH, Clinical Trials Unit, Bangor University, Bangor. United Kingdom;4. Nenagh Hospital, Nenagh, Ireland;5. Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Australia;1. HaEmek Medical Center, Rabin Blvd., Afula 18101, Israel;2. Rappaport School of Medicine, Technion- Israel Institute of Technology, Efron St., P.O.B. 9649, Bat Galim, Haifa 31096, Israel;3. Carmel Medical Center, 7 Michal St., Haifa 34362, Israel;4. Harvard Clinical Research Institute, 930 Commonwealth Ave., Boston, MA 02215, USA;1. Department of Invasive Cardiology, Kiepury 45, 64-100 Leszno, Poland;2. st;1. Department of Pharmacy, Nîmes University Hospital, Nîmes, France;2. Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, EA2415, University Institute of Clinical Research, Montpellier University, Montpellier, France;3. Department of Biostatistics, Epidemiology, Clinical Research and Health Economics, Nîmes University Hospital, Nîmes, France;4. Department of General Medicine, Nîmes University Hospital, Nîmes, France;5. Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes, France;1. Department of Internal Medicine, Chu Shang Show Chwan Hospital, Nantou, Taiwan;2. Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan |
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| Abstract: | IntroductionPatients 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.MethodsConsecutive 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.Results1178 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.ConclusionConcomitant 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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