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 journalArticle

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

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Venous Thromboembolism
Anticoagulants
Hemorrhage
Therapeutics
Platelet Aggregation Inhibitors
Amputation
Odds Ratio
Cause of Death
Lower Extremity
Extremities

Keywords

  • Anticoagulant
  • Antiplatelet
  • Venous thromboembolism

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

Tzoran, I., Brenner, B., Sakharov, G., Trujillo-Santos, J., Lorenzo, A., Madridano, O., ... Serrano, J. C. (2014). Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy. European Journal of Internal Medicine, 25(9), 821-825. https://doi.org/10.1016/j.ejim.2014.09.010

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

In: European Journal of Internal Medicine, Vol. 25, No. 9, 01.11.2014, p. 821-825.

Research output: Contribution to journalArticle

Tzoran, I, Brenner, B, Sakharov, G, Trujillo-Santos, J, Lorenzo, A, Madridano, O, López-Sáez, JB, Monreal, M, Andújar, V, Arcelus, JI, Auguet, T, Barba, R, Barrón, M, Barrón-Andrés, B, Bascuñana, J, Blanco-Molina, A, Bueso, T, Casado, I, Casillas, C, Conget, F, Del Molino, F, Del Toro, J, Falgá, C, Fernández-Capitán, C, Font, L, Gallego, P, García-Bragado, F, Gómez, V, González, J, González-Bachs, E, Guijarro, R, Guil, M, Gutiérrez, J, Hernández, L, Hernández-Huerta, S, Jara-Palomares, L, Jaras, MJ, Jiménez, D, Jiménez, R, Lobo, JL, López-Jiménez, L, López-Montes, L, López-Reyes, R, Lorente, MA, Luque, JM, Llutart, J, Marchena, PJ, Martín, M, Martín-Antorán, JM, Mellado, M, Nauffal, D, Nieto, JA, Ogea, JL, Otero, R, Pagán, B, Pedrajas, JM, Peris, ML, Porras, JA, Pons, I, Riera-Mestre, A, Rivas, A, Rodríguez-Dávila, MA, Román, P, Roncero, A, Rosa, V, Ruiz-Giménez, N, Ruiz, J, Sabio, P, Sahuquillo, JC, Samperiz, A, Sánchez, R, Sánchez Muñoz-Torrero, JF, Soler, S, Suriñach, JM, Tiberio, G, Tirado, R, Tolosa, C, Valero, B, Valle, R, Vela, J, Vidal, G, Villalobos, A, Vilella, V, Malfante, P, Villagra, M, Vivero, F, Verhamme, P, Peerlinck, K, Malý, R, Hirmerova, J, Kaletova, M, Bertoletti, L, Bura-Riviere, A, Farge-Bancel, D, Grange, C, Hij, A, Mahe, I, Merah, A, Quere, I, Schellong, S, Babalis, D, Papadakis, M, Tzinieris, I, Braester, A, Zeltser, D, Apollonio, A, Barillari, G, Ciammaichella, M, Di Micco, P, Duce, R, Guida, A, Maida, R, Mattei, L, Pace, F, Piovella, C, Pesavento, R, Poggio, R, Prandoni, P, Rota, L, Schenone, A, Tonello, D, Tufano, A, Visonà, A, Zalunardo, B, Santos, M, Bosevski, M, Kovacevic, D, Alatri, A, Bounameaux, H, Calanca, L, Mazzolai, L & Serrano, JC 2014, 'Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy', European Journal of Internal Medicine, vol. 25, no. 9, pp. 821-825. https://doi.org/10.1016/j.ejim.2014.09.010
Tzoran, Inna ; Brenner, Benjamin ; Sakharov, Gleb ; Trujillo-Santos, Javier ; Lorenzo, Alicia ; Madridano, Olga ; López-Sáez, Juan Bosco ; Monreal, Manuel ; Andújar, V. ; Arcelus, J. I. ; Auguet, T. ; Barba, R. ; Barrón, M. ; Barrón-Andrés, B. ; Bascuñana, J. ; Blanco-Molina, A. ; Bueso, T. ; Casado, I. ; Casillas, C. ; Conget, F. ; Del Molino, F. ; Del Toro, J. ; Falgá, C. ; Fernández-Capitán, C. ; Font, L. ; Gallego, P. ; García-Bragado, F. ; Gómez, V. ; González, J. ; González-Bachs, E. ; Guijarro, R. ; Guil, M. ; Gutiérrez, J. ; Hernández, L. ; Hernández-Huerta, S. ; Jara-Palomares, L. ; Jaras, M. J. ; Jiménez, D. ; Jiménez, R. ; Lobo, J. L. ; López-Jiménez, L. ; López-Montes, L. ; López-Reyes, R. ; Lorente, M. A. ; Luque, J. M. ; Llutart, J. ; Marchena, P. J. ; Martín, M. ; Martín-Antorán, J. M. ; Mellado, M. ; Nauffal, D. ; Nieto, J. A. ; Ogea, J. L. ; Otero, R. ; Pagán, B. ; Pedrajas, J. M. ; Peris, M. L. ; Porras, J. A. ; Pons, I. ; Riera-Mestre, A. ; Rivas, A. ; Rodríguez-Dávila, M. A. ; Román, P. ; Roncero, A. ; Rosa, V. ; Ruiz-Giménez, N. ; Ruiz, J. ; Sabio, P. ; Sahuquillo, J. C. ; Samperiz, A. ; Sánchez, R. ; Sánchez Muñoz-Torrero, J. F. ; Soler, S. ; Suriñach, J. M. ; Tiberio, G. ; Tirado, R. ; Tolosa, C. ; Valero, B. ; Valle, R. ; Vela, J. ; Vidal, G. ; Villalobos, A. ; Vilella, V. ; Malfante, P. ; Villagra, M. ; Vivero, F. ; Verhamme, P. ; Peerlinck, K. ; Malý, R. ; Hirmerova, J. ; Kaletova, M. ; Bertoletti, L. ; Bura-Riviere, A. ; Farge-Bancel, D. ; Grange, C. ; Hij, A. ; Mahe, I. ; Merah, A. ; Quere, I. ; Schellong, S. ; Babalis, D. ; Papadakis, M. ; Tzinieris, I. ; Braester, A. ; Zeltser, D. ; Apollonio, A. ; Barillari, G. ; Ciammaichella, M. ; Di Micco, P. ; Duce, R. ; Guida, A. ; Maida, R. ; Mattei, L. ; Pace, F. ; Piovella, C. ; Pesavento, R. ; Poggio, R. ; Prandoni, P. ; Rota, L. ; Schenone, A. ; Tonello, D. ; Tufano, A. ; Visonà, A. ; Zalunardo, B. ; Santos, M. ; Bosevski, M. ; Kovacevic, D. ; Alatri, A. ; Bounameaux, H. ; Calanca, L. ; Mazzolai, L. ; Serrano, J. C. / Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy. In: European Journal of Internal Medicine. 2014 ; Vol. 25, No. 9. pp. 821-825.
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title = "Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy",
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.",
keywords = "Anticoagulant, Antiplatelet, Venous thromboembolism",
author = "Inna Tzoran and Benjamin Brenner and Gleb Sakharov and Javier Trujillo-Santos and Alicia Lorenzo and Olga Madridano and L{\'o}pez-S{\'a}ez, {Juan Bosco} and Manuel Monreal and V. And{\'u}jar and Arcelus, {J. I.} and T. Auguet and R. Barba and M. Barr{\'o}n and B. Barr{\'o}n-Andr{\'e}s and J. Bascu{\~n}ana and A. Blanco-Molina and T. Bueso and I. Casado and C. Casillas and F. Conget and {Del Molino}, F. and {Del Toro}, J. and C. Falg{\'a} and C. Fern{\'a}ndez-Capit{\'a}n and L. Font and P. Gallego and F. Garc{\'i}a-Bragado and V. G{\'o}mez and J. Gonz{\'a}lez and E. Gonz{\'a}lez-Bachs and R. Guijarro and M. Guil and J. Guti{\'e}rrez and L. Hern{\'a}ndez and S. Hern{\'a}ndez-Huerta and L. Jara-Palomares and Jaras, {M. J.} and D. Jim{\'e}nez and R. Jim{\'e}nez and Lobo, {J. L.} and L. L{\'o}pez-Jim{\'e}nez and L. L{\'o}pez-Montes and R. L{\'o}pez-Reyes and Lorente, {M. A.} and Luque, {J. M.} and J. Llutart and Marchena, {P. J.} and M. Mart{\'i}n and Mart{\'i}n-Antor{\'a}n, {J. M.} and M. Mellado and D. Nauffal and Nieto, {J. A.} and Ogea, {J. L.} and R. Otero and B. Pag{\'a}n and Pedrajas, {J. M.} and Peris, {M. L.} and Porras, {J. A.} and I. Pons and A. Riera-Mestre and A. Rivas and Rodr{\'i}guez-D{\'a}vila, {M. A.} and P. Rom{\'a}n and A. Roncero and V. Rosa and N. Ruiz-Gim{\'e}nez and J. Ruiz and P. Sabio and Sahuquillo, {J. C.} and A. Samperiz and R. S{\'a}nchez and {S{\'a}nchez Mu{\~n}oz-Torrero}, {J. F.} and S. Soler and Suri{\~n}ach, {J. M.} and G. Tiberio and R. Tirado and C. Tolosa and B. Valero and R. Valle and J. Vela and G. Vidal and A. Villalobos and V. Vilella and P. Malfante and M. Villagra and F. Vivero and P. Verhamme and K. Peerlinck and R. Mal{\'y} and J. Hirmerova and M. Kaletova and L. Bertoletti and A. Bura-Riviere and D. Farge-Bancel and C. Grange and A. Hij and I. Mahe and A. Merah and I. Quere and S. Schellong and D. Babalis and M. Papadakis and I. Tzinieris and A. Braester and D. Zeltser and A. Apollonio and G. Barillari and M. Ciammaichella and {Di Micco}, P. and R. Duce and A. Guida and R. Maida and L. Mattei and F. Pace and C. Piovella and R. Pesavento and R. Poggio and P. Prandoni and L. Rota and A. Schenone and D. Tonello and A. Tufano and A. Vison{\`a} and B. Zalunardo and M. Santos and M. Bosevski and D. Kovacevic and A. Alatri and H. Bounameaux and L. Calanca and L. Mazzolai and Serrano, {J. C.}",
year = "2014",
month = "11",
day = "1",
doi = "10.1016/j.ejim.2014.09.010",
language = "English",
volume = "25",
pages = "821--825",
journal = "European Journal of Internal Medicine",
issn = "0953-6205",
publisher = "Elsevier B.V.",
number = "9",

}

TY - JOUR

T1 - Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy

AU - Tzoran, Inna

AU - Brenner, Benjamin

AU - Sakharov, Gleb

AU - Trujillo-Santos, Javier

AU - Lorenzo, Alicia

AU - Madridano, Olga

AU - López-Sáez, Juan Bosco

AU - Monreal, Manuel

AU - Andújar, V.

AU - Arcelus, J. I.

AU - Auguet, T.

AU - Barba, R.

AU - Barrón, M.

AU - Barrón-Andrés, B.

AU - Bascuñana, J.

AU - Blanco-Molina, A.

AU - Bueso, T.

AU - Casado, I.

AU - Casillas, C.

AU - Conget, F.

AU - Del Molino, F.

AU - Del Toro, J.

AU - Falgá, C.

AU - Fernández-Capitán, C.

AU - Font, L.

AU - Gallego, P.

AU - García-Bragado, F.

AU - Gómez, V.

AU - González, J.

AU - González-Bachs, E.

AU - Guijarro, R.

AU - Guil, M.

AU - Gutiérrez, J.

AU - Hernández, L.

AU - Hernández-Huerta, S.

AU - Jara-Palomares, L.

AU - Jaras, M. J.

AU - Jiménez, D.

AU - Jiménez, R.

AU - Lobo, J. L.

AU - López-Jiménez, L.

AU - López-Montes, L.

AU - López-Reyes, R.

AU - Lorente, M. A.

AU - Luque, J. M.

AU - Llutart, J.

AU - Marchena, P. J.

AU - Martín, M.

AU - Martín-Antorán, J. M.

AU - Mellado, M.

AU - Nauffal, D.

AU - Nieto, J. A.

AU - Ogea, J. L.

AU - Otero, R.

AU - Pagán, B.

AU - Pedrajas, J. M.

AU - Peris, M. L.

AU - Porras, J. A.

AU - Pons, I.

AU - Riera-Mestre, A.

AU - Rivas, A.

AU - Rodríguez-Dávila, M. A.

AU - Román, P.

AU - Roncero, A.

AU - Rosa, V.

AU - Ruiz-Giménez, N.

AU - Ruiz, J.

AU - Sabio, P.

AU - Sahuquillo, J. C.

AU - Samperiz, A.

AU - Sánchez, R.

AU - Sánchez Muñoz-Torrero, J. F.

AU - Soler, S.

AU - Suriñach, J. M.

AU - Tiberio, G.

AU - Tirado, R.

AU - Tolosa, C.

AU - Valero, B.

AU - Valle, R.

AU - Vela, J.

AU - Vidal, G.

AU - Villalobos, A.

AU - Vilella, V.

AU - Malfante, P.

AU - Villagra, M.

AU - Vivero, F.

AU - Verhamme, P.

AU - Peerlinck, K.

AU - Malý, R.

AU - Hirmerova, J.

AU - Kaletova, M.

AU - Bertoletti, L.

AU - Bura-Riviere, A.

AU - Farge-Bancel, D.

AU - Grange, C.

AU - Hij, A.

AU - Mahe, I.

AU - Merah, A.

AU - Quere, I.

AU - Schellong, S.

AU - Babalis, D.

AU - Papadakis, M.

AU - Tzinieris, I.

AU - Braester, A.

AU - Zeltser, D.

AU - Apollonio, A.

AU - Barillari, G.

AU - Ciammaichella, M.

AU - Di Micco, P.

AU - Duce, R.

AU - Guida, A.

AU - Maida, R.

AU - Mattei, L.

AU - Pace, F.

AU - Piovella, C.

AU - Pesavento, R.

AU - Poggio, R.

AU - Prandoni, P.

AU - Rota, L.

AU - Schenone, A.

AU - Tonello, D.

AU - Tufano, A.

AU - Visonà, A.

AU - Zalunardo, B.

AU - Santos, M.

AU - Bosevski, M.

AU - Kovacevic, D.

AU - Alatri, A.

AU - Bounameaux, H.

AU - Calanca, L.

AU - Mazzolai, L.

AU - Serrano, J. C.

PY - 2014/11/1

Y1 - 2014/11/1

N2 - 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.

AB - 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.

KW - Anticoagulant

KW - Antiplatelet

KW - Venous thromboembolism

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U2 - 10.1016/j.ejim.2014.09.010

DO - 10.1016/j.ejim.2014.09.010

M3 - Article

C2 - 25287697

AN - SCOPUS:84912574156

VL - 25

SP - 821

EP - 825

JO - European Journal of Internal Medicine

JF - European Journal of Internal Medicine

SN - 0953-6205

IS - 9

ER -