American Journal of Cardiology
Volume 104, Issue 9 , Pages 1171-1178 , 1 November 2009

Patient Characteristics Associated With the Choice of Triple Antithrombotic Therapy in Acute Coronary Syndromes

  • Jeremiah P. Depta, MD

      Affiliations

    • Department of Internal Medicine/Medicine Institute, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Christopher P. Cannon, MD

      Affiliations

    • TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
    • ,
  • Gregg C. Fonarow, MD

      Affiliations

    • University of California, Los Angeles, Medical Center, Los Angeles, California
    • ,
  • Xin Zhao, MS

      Affiliations

    • Duke Clinical Research Institute, Durham, North Carolina
    • ,
  • W. Frank Peacock, MD

      Affiliations

    • Department of Emergency Medicine, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Deepak L. Bhatt, MD, MPH

      Affiliations

    • Veterans Affairs Boston Healthcare System and Brigham and Women's Hospital, Boston, Massachusetts
    • Corresponding Author InformationCorresponding author: Tel: 1-857-203-6840/6841; fax: 1-857-203-5550
    • ,
  • Get With The Guidelines Steering Committee and Investigators

Received 16 March 2009 ,Revised 5 June 2009 ,Accepted 5 June 2009.

References 

  1. Depta JP, Bhatt DL. Aspirin and platelet adenosine diphosphate receptor antagonists in acute coronary syndromes and percutaneous coronary intervention: role in therapy and strategies to overcome resistance. Am J Cardiovasc Drugs. 2008;8:91–112
  2. Helton TJ, Bavry AA, Kumbhani DJ, Duggal S, Roukoz H, Bhatt DL. Incremental effect of clopidogrel on important outcomes in patients with cardiovascular disease: a meta-analysis of randomized trials. Am J Cardiovasc Drugs. 2007;7:289–297
  3. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al Guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2007;50:e1–e157
  4. King SB, Smith SC, Hirshfeld JW, Jacobs AK, Morrison DA, Williams DO, et al. 2007 Focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2008;51:172–209
  5. Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2007;2008:210–247
  6. Smaha LA. The American Heart Association Get With The Guidelines program. Am Heart J. 2004;148:S46–S48
  7. Goto S, Bhatt DL, Rother J, Alberts M, Hill MD, Ikeda Y, et al. Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. Am Heart J. 2008;156:855–863
  8. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. JAMA. 2001;285:2370–2375
  9. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:e25–e146
  10. Wang TY, Robinson LA, Ou FS, Roe MT, Ohman EM, Gibler WB, et al. Discharge antithrombotic strategies among patients with acute coronary syndrome previously on warfarin anticoagulation: physician practice in the CRUSADE registry. Am Heart J. 2008;155:361–368
  11. Orford JL, Fasseas P, Melby S, Burger K, Steinhubl SR, Holmes DR, et al. Safety and efficacy of aspirin, clopidogrel, and warfarin after coronary stent placement in patients with an indication for anticoagulation. Am Heart J. 2004;147:463–467
  12. Mattichak SJ, Reed PS, Gallagher MJ, Boura JA, O'Neill WW, Kahn JK. Evaluation of safety of warfarin in combination with antiplatelet therapy for patients treated with coronary stents for acute myocardial infarction. J Interv Cardiol. 2005;18:163–166
  13. Khurram Z, Chou E, Minutello R, Bergman G, Parikh M, Naidu S, et al. Combination therapy with aspirin, clopidogrel and warfarin following coronary stenting is associated with a significant risk of bleeding. J Invasive Cardiol. 2006;18:162–164
  14. DeEugenio D, Kolman L, DeCaro M, Andrel J, Chervoneva I, Duong P, et al. Risk of major bleeding with concomitant dual antiplatelet therapy after percutaneous coronary intervention in patients receiving long-term warfarin therapy. Pharmacotherapy. 2007;27:691–696
  15. Rossini R, Musumeci G, Lettieri C, Molfese M, Mihalcsik L, Mantovani P, et al. Long-term outcomes in patients undergoing coronary stenting on dual oral antiplatelet treatment requiring oral anticoagulant therapy. Am J Cardiol. 2008;102:1618–1623
  16. Lewis WR, Fonarow GC, LaBresh KA, Cannon CP, Pan W, Super DM, et al. Differential use of warfarin for secondary stroke prevention in patients with various types of atrial fibrillation. Am J Cardiol. 2009;103:227–231
  17. Nguyen MC, Lim YL, Walton A, Lefkovits J, Agnelli G, Goodman SG, et al. Combining warfarin and antiplatelet therapy after coronary stenting in the Global Registry of Acute Coronary events: is it safe and effective to use just one antiplatelet agent?. Eur Heart J. 2007;28:1717–1722
  18. Ruiz-Nodar JM, Marin F, Hurtado JA, Valencia J, Pinar E, Pineda J, et al. Anticoagulant and antiplatelet therapy use in 426 patients with atrial fibrillation undergoing percutaneous coronary intervention and stent implantation implications for bleeding risk and prognosis. J Am Coll Cardiol. 2008;51:818–825
  19. Lip GY, Karpha M. Anticoagulant and antiplatelet therapy use in patients with atrial fibrillation undergoing percutaneous coronary intervention: the need for consensus and a management guideline. Chest. 2006;130:1823–1827
  20. Kakar P, Lane D, Lip GY. Bleeding risk stratification models in deciding on anticoagulation in patients with atrial fibrillation: a useful complement to stroke risk stratification schema. Chest. 2006;130:1296–1299

 This study was supported by a grant from the Council on Clinical Cardiology of the American Heart Association, Dallas, Texas; the Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program is funded in part by the Merck Schering-Plough partnership, North Wales, Pennsylvania. Data collection and management were performed by Outcome Sciences, Cambridge, Massachusetts. The analysis of registry data were performed at Duke Clinical Research Institute, Durham, North Carolina, which also receives funding from the American Heart Association. The sponsor was not involved in the management, analysis, or interpretation of data or the preparation of the manuscript.

 Dr. Cannon has received research grants/support from Accumetrics (San Diego, California), AstraZeneca (London, UK), Bristol-Myers Squibb/Sanofi Partnership (Bridgewater, New Jersey), GlaxoSmithKline (Philadelphia, Pennsylvania), Intekrin Therapeutics (Los Altos, California), Merck (Whitehouse Station, New Jersey), Merck/Schering Plough Partnership, Novartis (East Hanover, New Jersey), and Takeda (Osaka, Japan). He serves as a clinical advisor and equity partner in Automedics Medical Systems (San Diego, California). He also serves as the chair of the Get With The Guidelines Steering Science Subcommittee; Dr. Fonarow has received research funding from GlaxoSmithKline and Medtronic (Minneapolis, Minnesota), served as consultant, and/or received honorarium from Bristol Myers Squibb (Princeton, New Jersey), GlaxoSmithKline, Medtronic, Merck, Pfizer (New York, New York), Sanofi-Aventis (Paris, France), and Schering Plough (Kenilworth, New Jersey) and serves as the chair of the Get With The Guidelines Steering Committee of the American Heart Association; Dr. Bhatt has received research grants from Bristol Myers Squibb, Sanofi Aventis, Heartscape (Columbia, Maryland), the Medicines Company (Parsippany, New Jersey), Eisai (Tokyo, Japan), and Ethicon (New Brunswick, New Jersey) and has served as a consultant to Arena (San Diego, California), Astellas (Tokyo, Japan), AstraZeneca, Bayer (Leverkusen, Germany), Bristol Myers Squibb, Cardax (Honolulu, Hawaii), Centocor (Horsham, Pennsylvania), Cogentus (Palo Alto, California), Daiichi Sankyo (Tokyo, Japan), Eisai, Eli Lilly (Indianapolis, Indiana), GlaxoSmithKline, Johnson & Johnson (New Brunswick, New Jersey), McNeil (New Brunswick, New Jersey), Medtronic, Millennium (Cambridge Massachusetts), Molecular Insights (Cambridge, Massachusetts), Otsuka (Rockville, Maryland), Paringenix (Tucson, Arizona), PDL (Redwood City, California), Philips (Amsterdam, Netherlands), Portola (San Francisco, California), Sanofi Aventis, Schering Plough, Takeda, the Medicines Company, and Vertex (Cambridge, Massachusetts); and Dr. Peacock has received research funding from Abbott (Abbott Park, Illinois), Biosite (San Diego, California), Brahms (Annapolis, Maryland), Cothera (San Mateo, California) Heartscape, Inovise (Beaverton, Oregon), Inverness (Waltham, Massachusetts), EKR (Bedminster, New Jersey), the Medicines Company, has served on the scientific advisory board for Abbott, Beckman-Coulter (Fullerton, California), Biosite, Heartscape, Inovise, Ortho-Clinical Diagnostics (Rochester, New York), and the Medicines Company, and has been on the speaker's bureau of Abbott and Biosite.

PII: S0002-9149(09)01253-3

doi: 10.1016/j.amjcard.2009.06.027

American Journal of Cardiology
Volume 104, Issue 9 , Pages 1171-1178 , 1 November 2009

Article Tools

* Image Usage & Resolution