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Article Dans Une Revue European Journal of Internal Medicine Année : 2014

Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy

Inna Tzoran
  • Fonction : Auteur
Benjamin Brenner
  • Fonction : Auteur
Gleb Sakharov
  • Fonction : Auteur
Javier Trujillo-Santos
  • Fonction : Auteur
Alicia Lorenzo
  • Fonction : Auteur
Olga Madridano
  • Fonction : Auteur
Juan Bosco López-Sáez
  • Fonction : Auteur
Manuel Monreal
  • Fonction : Auteur
  • PersonId : 928439
Riete Investigators
  • Fonction : Auteur

Résumé

INTRODUCTION: Patients with arterial disease receiving antiplatelet agents may develop venous thromboembolism (VTE) and need anticoagulant therapy, although concomitant use of these drugs may increase bleeding risk. We analyzed RIETE data and compared clinical outcomes depending on decision to discontinue or maintain antiplatelet therapy at VTE diagnosis. METHODS: Consecutive patients with acute VTE were enrolled in RIETE. Only patients receiving antiplatelet therapy at baseline were included in this analysis. Primary outcomes were: rate of subsequent ischemic events, major bleeding or death during anticoagulation course. RESULTS: 1178 patients who received antiplatelet drugs at VTE diagnosis were included. Antiplatelet therapy was discontinued in 62% of patients. During anticoagulation course, patients also receiving antiplatelet therapy had higher rates of lower limb amputations (2.28 vs. 0.21 events per 100 patients-years; p<0.01), any ischemic events (5.7 vs. 2.28 events per 100 patients-years; p<0.05) or death (23.6 vs. 13.9 deaths per 100 patients-years; p<0.01). No differences in the rate of major bleeding or recurrent VTE were revealed. In matched analysis, patients on antiplatelet therapy were found to have a significantly higher rate of limb amputations (odds ratio: 15.3; 95% CI: 1.02-229) and an increased number of composite outcomes including all-cause deaths, arterial and VTE events (odds ratio: 1.46; CI: 1.03-2.06), with no differences in major bleeding rate. CONCLUSION: Concomitant anticoagulant and antiplatelet therapy in patients with VTE and arterial disease is not associated with increased risk for bleeding, recurrent VTE or death. The worse outcome observed in patients who continued antiplatelet therapy requires further investigations.
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Dates et versions

hal-01945612 , version 1 (05-12-2018)

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Inna Tzoran, Benjamin Brenner, Gleb Sakharov, Javier Trujillo-Santos, Alicia Lorenzo, et al.. Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy. European Journal of Internal Medicine, 2014, 25 (9), pp.821-825. ⟨10.1016/j.ejim.2014.09.010⟩. ⟨hal-01945612⟩
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