Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular Atrial Fibrillation

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Date of download: 6/27/2016 Copyright © The American College of Cardiology. All rights reserved. From: Use and Outcomes of Triple Therapy Among Older Patients.

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Presentation transcript:

Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular Atrial Fibrillation Antonios Douros, MD, PhD, Christel Renoux, MD, PhD, Hui Yin, MSc, Kristian B. Filion, PhD, Samy Suissa, PhD, Laurent Azoulay, PhD The American Journal of Medicine Volume 132, Issue 2, Pages 191-199.e12 (February 2019) DOI: 10.1016/j.amjmed.2018.10.008 Copyright © 2018 Terms and Conditions

Figure 1 Flowchart describing the construction of base and study cohorts. DOAC = direct oral anticoagulant; VKA = vitamin K antagonist. The American Journal of Medicine 2019 132, 191-199.e12DOI: (10.1016/j.amjmed.2018.10.008) Copyright © 2018 Terms and Conditions

Figure 2 Forest plot summarizing the results of the primary analysis and sensitivity analyses, showing adjusted hazard ratios and 95% confidence intervals for the association between DOAC-antiplatelet concomitant use and risk of the three bleeding outcomes. CI = confidence interval; DOAC = direct oral anticoagulant; HR = hazard ratio. The American Journal of Medicine 2019 132, 191-199.e12DOI: (10.1016/j.amjmed.2018.10.008) Copyright © 2018 Terms and Conditions

Supplementary Figure 1 Diagram depicting cohort entry with different patterns of initiation of concomitant use of antithrombotic drugs. The black line represents person-time prior to cohort entry spanning from the diagnosis of nonvalvular atrial fibrillation to the initiation of the first antithrombotic drug (either an antiplatelet or an oral anticoagulant). The blue line represents person-time prior to cohort entry exposed to an oral anticoagulant (either a vitamin K antagonist [VKA] or a direct oral anticoagulant [DOAC]). Red line represents person-time prior to cohort entry exposed to at least one antiplatelet. Cohort entry corresponded to the initiation of DOAC-antiplatelet or VKA-antiplatelet concomitant use. Red-and-blue line represents person-time after cohort entry. Scenario A corresponds to cohort entry upon addition of a DOAC or a VKA to at least one antiplatelet, scenario B corresponds to cohort entry upon addition of at least one antiplatelet to a DOAC or a VKA, and scenario C corresponds to cohort entry upon concomitant initiation of a DOAC or a VKA and at least one antiplatelet. AP = antiplatelet; DOAC = direct oral anticoagulant; NVAF = nonvalvular atrial fibrillation; VKA = vitamin K antagonist. The American Journal of Medicine 2019 132, 191-199.e12DOI: (10.1016/j.amjmed.2018.10.008) Copyright © 2018 Terms and Conditions

Supplementary Figure 2 Cumulative incidence of intracranial hemorrhage among concomitant DOAC-antiplatelet and VKA-antiplatelet users. DOAC = direct oral anticoagulant; VKA = vitamin K antagonist. The American Journal of Medicine 2019 132, 191-199.e12DOI: (10.1016/j.amjmed.2018.10.008) Copyright © 2018 Terms and Conditions

Supplementary Figure 3 Cumulative incidence of gastrointestinal bleeding among concomitant DOAC-antiplatelet and VKA-antiplatelet users. DOAC = direct oral anticoagulant; VKA = vitamin K antagonist. The American Journal of Medicine 2019 132, 191-199.e12DOI: (10.1016/j.amjmed.2018.10.008) Copyright © 2018 Terms and Conditions

Supplementary Figure 4 Cumulative incidence of other major bleeding among concomitant DOAC-antiplatelet and VKA-antiplatelet users. DOAC = direct oral anticoagulant; VKA = vitamin K antagonist. The American Journal of Medicine 2019 132, 191-199.e12DOI: (10.1016/j.amjmed.2018.10.008) Copyright © 2018 Terms and Conditions