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

Inna Tzoran, Benjamin Brenner, Gleb Sakharov, Javier Trujillo-Santos, Alicia Lorenzo, Olga Madridano, Juan Bosco López-Sáez, Manuel Monreal, V. Andújar, J. I. Arcelus, T. Auguet, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, I. Casado, C. Casillas, F. CongetF. Del Molino, J. Del Toro, C. Falgá, C. Fernández-Capitán, L. Font, P. Gallego, F. García-Bragado, V. Gómez, J. González, E. González-Bachs, R. Guijarro, M. Guil, J. Gutiérrez, L. Hernández, S. Hernández-Huerta, L. Jara-Palomares, M. J. Jaras, D. Jiménez, R. Jiménez, J. L. Lobo, L. López-Jiménez, L. López-Montes, R. López-Reyes, M. A. Lorente, J. M. Luque, J. Llutart, P. J. Marchena, M. Martín, J. M. Martín-Antorán, M. Mellado, D. Nauffal, J. A. Nieto, J. L. Ogea, R. Otero, B. Pagán, J. M. Pedrajas, M. L. Peris, J. A. Porras, I. Pons, A. Riera-Mestre, A. Rivas, M. A. Rodríguez-Dávila, P. Román, A. Roncero, V. Rosa, N. Ruiz-Giménez, J. Ruiz, P. Sabio, J. C. Sahuquillo, A. Samperiz, R. Sánchez, J. F. Sánchez Muñoz-Torrero, S. Soler, J. M. Suriñach, G. Tiberio, R. Tirado, C. Tolosa, B. Valero, R. Valle, J. Vela, G. Vidal, A. Villalobos, V. Vilella, P. Malfante, M. Villagra, F. Vivero, P. Verhamme, K. Peerlinck, R. Malý, J. Hirmerova, M. Kaletova, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, C. Grange, A. Hij, I. Mahe, A. Merah, I. Quere, S. Schellong, D. Babalis, M. Papadakis, I. Tzinieris, A. Braester, D. Zeltser, A. Apollonio, G. Barillari, M. Ciammaichella, P. Di Micco, R. Duce, A. Guida, R. Maida, L. Mattei, F. Pace, C. Piovella, R. Pesavento, R. Poggio, P. Prandoni, L. Rota, A. Schenone, D. Tonello, A. Tufano, A. Visonà, B. Zalunardo, M. Santos, M. Bosevski, D. Kovacevic, A. Alatri, H. Bounameaux, L. Calanca, L. Mazzolai, J. C. Serrano

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Patients with arterial disease receiving antiplatelet agents may develop venous thromboembolism (VTE) and need anticoagulant therapy, although concomitant use of these drugsmay 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 patientswho 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 patientsyears; p <0.01). No differences in the rate of major bleeding or recurrent VTEwere 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.

Original languageEnglish
Pages (from-to)821-825
Number of pages5
JournalEuropean Journal of Internal Medicine
Volume25
Issue number9
DOIs
Publication statusPublished - Nov 1 2014

Keywords

  • Anticoagulant
  • Antiplatelet
  • Venous thromboembolism

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

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