Comparison of effects of triple antithrombotic therapy and dual antiplatelet therapy on long-term outcomes of acute myoc
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ORIGINAL ARTICLE
Comparison of effects of triple antithrombotic therapy and dual antiplatelet therapy on long‑term outcomes of acute myocardial infarction Mei‑Tzu Wang1 · Cheng Chung Hung1 · Kun‑Chang Lin1 · Guang‑Yuan Mar1 · Shu‑Hung Kuo1 · Cheng‑Hung Chiang1,2,3 · Chin‑Chang Cheng1,3 · Feng‑You Kuo1,3 · Hsing‑Li Liang1,3 · Wei‑Chun Huang1,2,3 Received: 3 May 2020 / Accepted: 25 September 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Warfarin is an alternate choice for patients who are not eligible for non-vitamin K oral anticoagulants after acute myocardial infarction (AMI). This study aimed to compare the long-term outcome of triple antithrombotic therapy (TAT) with that of dual antiplatelet therapy (DAPT) after AMI. This was a nationwide, propensity score-matched, case–control study of 186,112 first AMI patients, of whom 2,825 received TAT comprising aspirin, clopidogrel, and warfarin. Propensity score matching in a ratio of 1:4 by age, sex, comorbidities, and treatment was adopted, Finally, 2,813 AMI patients and 11,252 matched controls that were administered TAT and DAPT (aspirin and clopidogrel), respectively, were included in our analysis. The 12-year overall survival rate did not differ between both strategies (P = .3167). TAT was beneficial in old age (hazard ratio [HR] = 0.92), female sex (HR = 0.86), atrial fibrillation (AF) (HR = 0.80), hypertension (HR = 0.92), cerebrovascular accident (HR = 0.90), and in the absence of percutaneous coronary intervention (HR = 0.79). TAT reduced the rate of recurrent myocardial infarction (P = .0108) but did not affect the rate of stroke (P = .4867), gastrointestinal bleeding (P = .3889), or intracranial hemorrhage (ICH) (P = .3449). TAT reduces the incidence of recurrent myocardial infarction and does not increase the risk of major bleeding, while compared to DAPT. Keywords Acute myocardial infarction · Antiplatelet therapy · Triple antithrombotic therapy · Warfarin
Introduction Atherothrombosis is commonly associated with ischemic complications, leading to acute coronary syndrome, a major cause of death and disability worldwide [1]. Aspirin has been proven to reduce the risk of symptomatic Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00380-020-01708-8) contains supplementary material, which is available to authorized users. * Wei‑Chun Huang [email protected] 1
Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 813, Taiwan
2
School of Medicine, National Yang-Ming University, Taipei, Taiwan
3
Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
atherothrombosis by approximately 20% in high-risk groups [2]. When comparing Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE) trial, clopidogrel provided an additional 8.7% relative risk reduction in patients with ischemic stroke, myocardial infraction (MI) or vascular death compared with aspirin [3]. Early percu
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