Accepted Manuscript Reply to Letter to the Editor: Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients after Myocardial Infarction and Coronary Intervention Morten Lamberts, MD, PhD Gunnar H. Gislason, MD, PhD(FACC) Jonas Bjerring Olesen, MD, PhD Søren Lund Kristensen, MD Anne-Marie Schjerning Olsen, MD Anders Mikkelsen, MB Christine Benn Christensen, MD Gregory YH. Lip, MD(FACC) Lars Køber, MD, DMSc Christian Torp-Pedersen, MD, DMSc(FACC) Morten Lock Hansen, MD, PhD PII:
S0735-1097(14)00277-0
DOI:
10.1016/j.jacc.2013.11.049
Reference:
JAC 19744
To appear in:
Journal of the American College of Cardiology
Received Date: 19 November 2013 Accepted Date: 21 November 2013
Please cite this article as: Lamberts M, Gislason GH, Olesen JB, Kristensen SL, Schjerning Olsen AM, Mikkelsen A, Christensen CB, Lip GY, Køber L, Torp-Pedersen C, Hansen ML, Reply to Letter to the Editor: Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients after Myocardial Infarction and Coronary Intervention, Journal of the American College of Cardiology (2014), doi: 10.1016/ j.jacc.2013.11.049. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Reply to Letter to the Editor: Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients after Myocardial Infarction and Coronary Intervention
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Morten Lamberts, MD, PhD* †; Gunnar H Gislason, MD, PhD*,‡¶(FACC); Jonas Bjerring Olesen, MD, PhD*; Søren Lund Kristensen, MD*; Anne-Marie Schjerning Olsen, MD*; Anders Mikkelsen, MB*; Christine Benn Christensen, MD*; Gregory YH Lip, MD†(FACC) Lars Køber, MD, DMSc††; Christian Torp-Pedersen, MD, DMSc*#(FACC); Morten Lock Hansen, MD, PhD* *
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Denmark ¶ National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark † University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK †† Department of Cardiology, the Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark # Institute of Health, Science and Technology, Aalborg University, Denmark
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Conflicts of interest: None declared.
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‡
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EP
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Correspondence: Morten Lamberts MD, PhD Department of Cardiology – post 635 Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark. Fax: (+45) 70 20 12 83 Tel.: (+45) 22 43 41 86 E-mail: [email protected]
1
ACCEPTED MANUSCRIPT Aytürk and colleagues emphasize that type of stent might affect the risk of stent thrombosis and consequently the need of prolonged dual antiplatelet therapy with aspirin and clopidogrel. We agree that the area is complex, but physicians should acknowledge that current guidelines are based on Level C evidence (1,2). In our opinion, there is no evidence to
RI PT
suggest that dual antiplatelet therapy is necessary in patients that receive oral anticoagulation which itself offers coronary protection (3). Our registry based study and one randomized study support the use of clopidogrel in addition to vitamin K antagonist (without aspirin) in
SC
patients with atrial fibrillation discharged after myocardial infarction or percutaneous
coronary intervention (4). While most stents implanted in recent years are drug-eluting stents,
M AN U
we acknowledge the important limitation of our data that no information on stent type was available. However, there is no indication that stent type should affect the risk of bleeding. Aytürk and colleagues wisely highlight that it is a multifaceted challenge when prescribing numerous antithrombotic drugs, and we would like to add to the ongoing and important
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discussion that bleeding risk merit serious attention. Indeed, a bleeding event per se is associated with increased mortality, blood transfusion is associated with poorer prognosis and minor bleedings could result in discontinuation of life-saving antithrombotic therapies (5).
EP
This is emphasized by use of bleeding as primary endpoint in many contemporary trials of
AC C
antiplatelet use following stent implantation. Until more randomized trial data are available, careful assessment of bleeding risk and recognizing current (though sparse) evidence is crucial when individualizing antithrombotic therapy in patients with atrial fibrillation suffering from an acute coronary event with or without stent implantation (6). Due to bleeding complications, interventionists should carefully consider the need for a drug-eluting stent compared to a bare-metal stent and carefully consider the indication for stent implantation.
2
ACCEPTED MANUSCRIPT References 1. Huber K, Lip GY. Differences between ACC/AHA and ESC Guidelines on antiplatelet therapy in patients with acute coronary syndromes. Thromb Haemost. 2013 Jul 1;110(1):113.
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2. Faxon DP, Eikelboom JW, Berger PB et al. Consensus document: antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting. A North-American perspective. Thromb Haemost. 2011 Oct;106(4):572-84.
SC
3. Hurlen M, Abdelnoor M, Smith P, Erikssen J, Arnesen H. Warfarin, aspirin, or both after myocardial infarction. N Engl J Med. 2002 Sep 26;347(13):969-74.
M AN U
4. Dewilde WJ, Oirbans T, Verheugt FW et al. WOEST study investigators: Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15.
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5. Steg PG, Huber K, Andreotti F et al. Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart J. 2011 Aug;32(15):1854-64.
EP
6. Marin F, Huber K, Lip GYH: Antithrombotic therapy in atrial fibrillation and stent
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implantation: treatment or threats by the use of triple or dual antithrombotic therapy. Thromb Haemost. 2013 Sep 27;110(4):623-5.
3
S0735-1097(14)00277-0
DOI:
10.1016/j.jacc.2013.11.049
Reference:
JAC 19744
To appear in:
Journal of the American College of Cardiology
Received Date: 19 November 2013 Accepted Date: 21 November 2013
Please cite this article as: Lamberts M, Gislason GH, Olesen JB, Kristensen SL, Schjerning Olsen AM, Mikkelsen A, Christensen CB, Lip GY, Køber L, Torp-Pedersen C, Hansen ML, Reply to Letter to the Editor: Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients after Myocardial Infarction and Coronary Intervention, Journal of the American College of Cardiology (2014), doi: 10.1016/ j.jacc.2013.11.049. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Reply to Letter to the Editor: Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients after Myocardial Infarction and Coronary Intervention
RI PT
Morten Lamberts, MD, PhD* †; Gunnar H Gislason, MD, PhD*,‡¶(FACC); Jonas Bjerring Olesen, MD, PhD*; Søren Lund Kristensen, MD*; Anne-Marie Schjerning Olsen, MD*; Anders Mikkelsen, MB*; Christine Benn Christensen, MD*; Gregory YH Lip, MD†(FACC) Lars Køber, MD, DMSc††; Christian Torp-Pedersen, MD, DMSc*#(FACC); Morten Lock Hansen, MD, PhD* *
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Denmark ¶ National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark † University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK †† Department of Cardiology, the Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark # Institute of Health, Science and Technology, Aalborg University, Denmark
M AN U
Conflicts of interest: None declared.
SC
‡
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EP
TE D
Correspondence: Morten Lamberts MD, PhD Department of Cardiology – post 635 Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark. Fax: (+45) 70 20 12 83 Tel.: (+45) 22 43 41 86 E-mail: [email protected]
1
ACCEPTED MANUSCRIPT Aytürk and colleagues emphasize that type of stent might affect the risk of stent thrombosis and consequently the need of prolonged dual antiplatelet therapy with aspirin and clopidogrel. We agree that the area is complex, but physicians should acknowledge that current guidelines are based on Level C evidence (1,2). In our opinion, there is no evidence to
RI PT
suggest that dual antiplatelet therapy is necessary in patients that receive oral anticoagulation which itself offers coronary protection (3). Our registry based study and one randomized study support the use of clopidogrel in addition to vitamin K antagonist (without aspirin) in
SC
patients with atrial fibrillation discharged after myocardial infarction or percutaneous
coronary intervention (4). While most stents implanted in recent years are drug-eluting stents,
M AN U
we acknowledge the important limitation of our data that no information on stent type was available. However, there is no indication that stent type should affect the risk of bleeding. Aytürk and colleagues wisely highlight that it is a multifaceted challenge when prescribing numerous antithrombotic drugs, and we would like to add to the ongoing and important
TE D
discussion that bleeding risk merit serious attention. Indeed, a bleeding event per se is associated with increased mortality, blood transfusion is associated with poorer prognosis and minor bleedings could result in discontinuation of life-saving antithrombotic therapies (5).
EP
This is emphasized by use of bleeding as primary endpoint in many contemporary trials of
AC C
antiplatelet use following stent implantation. Until more randomized trial data are available, careful assessment of bleeding risk and recognizing current (though sparse) evidence is crucial when individualizing antithrombotic therapy in patients with atrial fibrillation suffering from an acute coronary event with or without stent implantation (6). Due to bleeding complications, interventionists should carefully consider the need for a drug-eluting stent compared to a bare-metal stent and carefully consider the indication for stent implantation.
2
ACCEPTED MANUSCRIPT References 1. Huber K, Lip GY. Differences between ACC/AHA and ESC Guidelines on antiplatelet therapy in patients with acute coronary syndromes. Thromb Haemost. 2013 Jul 1;110(1):113.
RI PT
2. Faxon DP, Eikelboom JW, Berger PB et al. Consensus document: antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting. A North-American perspective. Thromb Haemost. 2011 Oct;106(4):572-84.
SC
3. Hurlen M, Abdelnoor M, Smith P, Erikssen J, Arnesen H. Warfarin, aspirin, or both after myocardial infarction. N Engl J Med. 2002 Sep 26;347(13):969-74.
M AN U
4. Dewilde WJ, Oirbans T, Verheugt FW et al. WOEST study investigators: Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15.
TE D
5. Steg PG, Huber K, Andreotti F et al. Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart J. 2011 Aug;32(15):1854-64.
EP
6. Marin F, Huber K, Lip GYH: Antithrombotic therapy in atrial fibrillation and stent
AC C
implantation: treatment or threats by the use of triple or dual antithrombotic therapy. Thromb Haemost. 2013 Sep 27;110(4):623-5.
3
