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Efficacy and safety of triple therapy with novel oral anticoagulants for ischemic heart disease with atrial fibrillation in japan

Session Poster session 2

Speaker Hideo Amano

Event : ESC Congress 2015

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes – Pathophysiology and Mechanisms
  • Session type : Poster Session

Authors : H Amano (Tokyo,JP), T Ikeda (Tokyo,JP), M Toda (Tokyo,JP), R Okubo (Tokyo,JP), T Yabe (Tokyo,JP), I Watanabe (Tokyo,JP), D Saito (Tokyo,JP)

Authors:
H. Amano1 , T. Ikeda1 , M. Toda1 , R. Okubo1 , T. Yabe1 , I. Watanabe1 , D. Saito1 , 1Toho University Omori Medical Center, Division of Interventional Cardiology, Cardiovascular Center - Tokyo - Japan ,

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 233

Background: Novel oral anticoagulants (NOACs) were available in Japan few years ago. The efficacy and safety of triple therapy [double-antiplatelet therapy (DAPT) and a NOAC] is unclear in Japan.

Objective: This study aimed to assess the efficacy and safety of triple therapy with NOACs comparing to vitamin K antagonists (VKA).

Methods: Subjects were 323 patients received antiplatelet drugs or anticoagulant drugs to prevent thrombosis or embolization. Subjects were divided into the N group that a NOAC only used, the N2 group that a NOAC and an antiplatelet drug used, the N3 group that a NOAC and double antiplatelet drugs, the W2 group that VKA and an antiplatelet drug, the W3 group that VKA and double antiplatelet drugs, and the DAPT group that double platelet drugs used.

Results: The results are shown in the following table.

Conclusion: Triple therapy with a NOAC and DAPT had lower major bleeding events than the VKA and DAPT. Bleeding mainly occurred in three months later. Bleeding cases with NOACs had more frequent chronic kidney disease than VKA.

Triple therapy with NOAC or VKA had high MACCE. In Japan, NOACs were safety and effective for the triple therapy.

Backgrounds of bleeding cases
DAPT groupN groupN2 groupN3 groupW2 groupW3 group
(n=104)(n=125)(n=39)(n=15)(n=9)(n=30)
Major bleeding events2 (2%)2 (2%)01 (7%)2 (22%)*7 (23%)*
Gastrointestinal210116
Intracranial010011
Backgrounds of bleeding cases
  Age (years)69±281±57070±670±13
  Male/female2/00/20/11/16/1
  Body weight (kg)74±3639±165368±1755±14
  CKD2 (100%)2 (100%)1 (100%)0 (0%)3 (43%)
  eGFR (ml/min/1.73m2)10.7±6.035.9±4.934.289.3±36.651.6±21.3
Duration from medication to bleeding
  0–3 months0 (0%)0 (0%)0 (0%)0 (0%)1 (14%)
  3–6 months1 (50%)1 (50%)1 (50%)1 (50%)4 (57%)
  6 months–1 (50%)1 (50%)1 (50%)1 (50%)2 (29%)
  MACCE6 (6%)5 (4%)5 (4%)3 (20%)**1 (11%)6 (20%)**
*P<0.01 (vs. DAPT, N, N2, N3 group), **P<0.01 (vs. DAPT, N, N2, W2 group). CKD, chronic kidney disease; MACCE, cardiac death, acute myocardial infarction, cardiac failure, stroke.

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