Anticoagulant plus antiplatelet treatment increased the risk of bleeding in atrial fibrillation

doi:10.1136/ebm.10.2.56

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	EBM Aetiology

Evidence-Based Medicine 2005; 10:56
© 2005 BMJ Publishing Group Ltd.

Aetiology

Anticoagulant plus antiplatelet treatment increased the risk of bleeding in atrial fibrillation

Shireman TI, Howard PA, Kresowik TF, et al. Combined anticoagulant-antiplatelet use and major bleeding events in elderly atrial fibrillation patients. Stroke 2004;35:2362–7.[Abstract/Free Full Text]

Q What is the effect of concomitant anticoagulant and antiplatelet treatment on the risk of major bleeding in older patients with atrial fibrillation (AF)?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Internal medicine $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Haematology $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Cardiology $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$

Key Words: atrial fibrillation • platelet aggregation inhibitors • anticoagulants

The first 150 words of the full text of this article appear below.

METHODS
Design: retrospective cohort analysis within the US National StrokeProject.

Setting: USA.

Patients: 10 093 patients $>=$ 65 years of age (mean age 77 y, 51% men) whowere admitted to hospital for AF and had warfarin dischargetreatment. Exclusion criteria: transfer to another acute carehospital, death during hospitalisation, or discharge againsthospital advice.

Risk factors: age, sex, comorbid conditions (coronary or valvular heart disease,diabetes, previous cerebrovascular event, hypertension, andcongestive heart failure), bleeding risk factors (previous bleeding,anaemia during the index hospital admission, ulcer, risk offalls, alcohol use, hepatic disease, dementia, cancer, and concurrentmedications), and warfarin use before admission.

Outcomes: antiplatelet drug use after hospital discharge and hospitaladmission for acute bleed within 90 days.

MAIN RESULTS
1962 patients (19.4%) were prescribed an antiplatelet at discharge(aspirin [90%], aspirin plus clopidogrel or ticlopidine [6%],or ticlopidine alone [4%]). Bleeding events increased from 1.3%in warfarin only users to . . . [Full text of this article]

Apoor S Gami, MD

Mayo Clinic College of Medicine
Rochester, Minnesota, USA