Abstract Number: PB2408
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment
Background: Concomitant use of anticoagulant and antiplatelet therapy increases the bleeding risk, but most of the data derived from patients with atrial fibrillation. Data in patients with venous thromboembolism (VTE) are limited.
Aims: To report the management and evolution of patients diagnosed with acute VTE while receiving antiplatelet treatment.
Methods: We performed a post-hoc analysis of patients included in two prospective registries, sharing the same case report form, from 2007 to 2017. The primary outcome was the proportion of patients discharged with concomitant anticoagulant and antiplatelet therapy. Secondary outcomes were clinically relevant bleeding, cardiovascular events (including myocardial ischemia, ischemic stroke and lower limb ischemia), recurrent VTE and death, during the follow-up, according to the continuation of antiplatelet therapy.
Results: Among the 1,702 patients with acute VTE, 272 (15.89%) were receiving antiplatelet treatment at the diagnosis, of whom 62 (22.7%) were discharged with concomitant anticoagulant and antiplatelet therapy. These patients were younger (mean age: 73.2 ±11.8 vs 77.2 ± 14.5, p=0,003), had more often history of dyslipidemia (55.7% vs 37.3%, p=0,017), myocardial ischemia (55.7% vs 21.8%, p< 0,001) and peripheral arterial diseases (36.1% vs 13.5%, p< 0,001). Clinically relevant bleedings rate (after a mean follow-up of 18.4 ± 19.1 months of follow up) was increased in patients discharged with concomitant anticoagulant and antiplatelet therapy (HR=2.43; 95%CI [1.06-5.57]) as compared with patients with antiplatelet discontinuation. There were no difference in terms of cardiovascular events, VTE recurrence and death among groups (table 1). On multivariable analysis, being discharged with concomitant anticoagulant and antiplatelet therapy was associated with an increased risk of clinically relevant bleeding (HR=6.5; 95%CI [2.8-15.7]).
anticoagulant and antiplatelet therapy | Anticoagulant therapy | OR (IC 95%) | |
Patients, n | n=61 | n=193 | |
Clinically Relevant Bleeding | 9 (14.8%) | 16 (8.3%) | 2.43 (1.06-5.57) |
time (mean months ± SD) | 8.6 ± 13.3 | 7.0 ± 12.9 | |
VTE recurrence | 0 | 3 (1.6% | |
Cardiovascular Event | 5 (8.2%) | 13 (6.7%) | 1.24 (0.42-3.63) |
Death | 8 (13.1%) | 29 (15.0%) | 0.85 (0.37-1.97) |
time (mean months ± SD) | 6.8 ± 5.5 | 7.4 ± 6.2 | |
Fatal bleeding | 1 (1.6%) | 3 (1.6%) | |
Fatal ischemic cardiovascular event | 0 | 2 (1.0%) |
[Clinical outcome during the follow-up]
Conclusions: Among the 15% of patients who presented VTE under antiplatelet, one in five are discharged with concomitant anticoagulant and antiplatelet therapy. These patients had an increased risk of clinically relevant bleeding during follow-up.
To cite this abstract in AMA style:
Giraud M, Catella J, Cognet L, Helfer H, Accassat S, Mismetti P, Mahe I, Bertoletti L. Management of Acute Venous Thromboembolism in Patients Taking Antiplatelet Therapy: A Bi-Center Analysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/management-of-acute-venous-thromboembolism-in-patients-taking-antiplatelet-therapy-a-bi-center-analysis/. Accessed March 22, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/management-of-acute-venous-thromboembolism-in-patients-taking-antiplatelet-therapy-a-bi-center-analysis/