{"id":95,"date":"2010-02-08T17:44:23","date_gmt":"2010-02-08T16:44:23","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=95"},"modified":"2015-11-12T13:51:47","modified_gmt":"2015-11-12T12:51:47","slug":"increased-use-of-antithrombotics-increases-hospital-admissions-for-bleeding","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2010\/02\/08\/increased-use-of-antithrombotics-increases-hospital-admissions-for-bleeding\/","title":{"rendered":"Increased use of antithrombotics increases hospital admissions for bleeding"},"content":{"rendered":"

The safety of multiple antithrombotic drug regimes has not been investigated in clinical trials.\u00a0 Specifically, guidelines for the management of patients with myocardial infarction who also have an indication for warfarin are currently unclear; some recommend the use of clopidogrel and warfarin in combination following coronary stent implantation.\u00a0 As bleeding episodes following myocardial infarction are associated with increased morbidity and mortality, the use of undocumented treatment combinations raises concerns.<\/p>\n

Sorensen and colleagues used nationwide registers from Denmark to identify 40812 patients who had been admitted to hospital with first time myocardial infarction (MI) between 2000 and 2005.\u00a0 The authors examined the prescriptions started at discharge to divide the patients in to groups of: monotherapy with aspirin, clopidogrel, or warfarin; dual therapy with any two of the preceeding agents; or triple therapy.\u00a0 The risk of hospital admission for bleeding, recurrent MI, and death were assessed by Cox proportional hazards models with the drug exposure groups as time-varying covariates.\u00a0 The main results are summarised in table 1.<\/p>\n

Table 1: Risk of bleeding following myocardial infarction according to antithrombotic agents given<\/p>\n

http:\/\/heart.bmj.com\/site\/misc\/March1.pdf<\/a><\/p>\n

Conclusions:
\nFollowing myocardial infarction, the risk of hospital admission for bleeding increases with the number of antithrombotic drugs used.\u00a0 The highest risk is seen with triple therapy or the use of clopidogrel and vitamin K antagonists;\u00a0 this combination should only be prescribed on a case-by-case basis.<\/p>\n

\u2022\u00a0\u00a0\u00a0 Sorensen R, Hansen ML, Abildstrom SZ et al.\u00a0 Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data.\u00a0 Lancet 2009:374;1967-1974.<\/p>\n","protected":false},"excerpt":{"rendered":"

The safety of multiple antithrombotic drug regimes has not been investigated in clinical trials.\u00a0 Specifically, guidelines for the management of patients with myocardial infarction who also have an indication for warfarin are currently unclear; some recommend the use of clopidogrel and warfarin in combination following coronary stent implantation.\u00a0 As bleeding episodes following myocardial infarction are […]<\/p>\n

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