Characteristics and outcomes in patients with atrial fibrillation and acute coronary syndrome treated with ticagrelor and novel oral anticoagulants

Jesper van der Pals, Fredrik Holmqvist, Rasmus Borgquist, Matthias Götberg, Mohaned Nseir, Sasha Koul, Nazim Isma, Fredrik Scherstén, Patrik Tydén, Oscar Braun, David Erlinge

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Optimal antithrombotic treatment after an acute coronary syndrome (ACS) in patients with atrial fibrillation is unclear. Data on outcomes in patients on concomitant ticagrelor and the novel oral anticoagulants (NOAC) is scarce. This study therefore sought to describe patient characteristics and treatment outcomes in patients with atrial fibrillation and ACS treated with concomitant ticagrelor and NOACs (double antithrombotic therapy, DT). Materials and methods: We retrospectively identified all ACS patients with atrial fibrillation on DT upon discharge from Skåne University Hospital in Lund, Sweden, between 2016 and 2019. Identified patients were compared with age and sex matched controls with ACS alone treated with ticagrelor and aspirin (DAPT). Major bleeding was defined in accordance with the HAS-BLED derivation study. Patients were retrospectively followed for six months. Results: In total, 341 patients on DT were identified and compared with 341 controls on DAPT. Mean HAS-BLED bleeding risk score was higher in patients on DT (2.9 ± 1.0 vs 2.6+/0.9 units, p < 0.001; DT vs DAPT). The incidence of major bleeding was higher in patients on DT (31 (9.1%) vs 10 (2.9%), p = 0.001; DT vs DAPT), while a composite of all thrombotic events was found to be similar between the groups (8 (2.3%) vs 5 (1.5%), p = NS; DT vs DAPT). Conclusions: While thrombotic events occur at a similar rate, the bleeding rate is higher in patients with atrial fibrillation and ACS treated with DT than in patients with ACS alone treated with DAPT. Patients with atrial fibrillation also have a higher basal bleeding risk.

Original languageEnglish
Article number100054
Number of pages5
JournalThrombosis Update
Volume3
DOIs
Publication statusPublished - 2021 May

Bibliographical note

Publisher Copyright:
© 2021 The Authors

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

Keywords

  • Acute coronary syndrome
  • Antithrombotic therapy
  • Novel oral anticoagulants
  • Ticagrelor

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