Dual Antithrombotic Therapy Increases Severe Bleeding Events in Patients With Stroke and Cardiovascular Disease
- 1 June 2008
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 39 (6), 1740-1745
- https://doi.org/10.1161/strokeaha.107.504993
Abstract
Background and Purpose— We sought to determine the incidence and severity of bleeding events in patients with stroke and cardiovascular diseases who were taking oral antithrombotic agents in Japan, where the incidence of hemorrhagic stroke is higher than in Western countries. Methods— A prospective, multicenter, observational study was conducted; 4009 patients who were taking oral antithrombotic agents for stroke and cardiovascular diseases were enrolled. The patients were classified into 4 groups according to their antithrombotic treatment: the single antiplatelet agent group (47.2%); the dual antiplatelet agent group (8.7%); the warfarin group (32.4%); and the warfarin plus antiplatelet agent group (11.7%). The primary end point was life-threatening or major bleeding according to the MATCH trial definition. Results— During a median follow-up of 19 months, there were 57 life-threatening and 51 major bleeding events, including 31 intracranial hemorrhages. The annual incidence of the primary end point was 1.21% in the single antiplatelet agent group, 2.00% in the dual antiplatelet agent group, 2.06% in the warfarin group, and 3.56% in the warfarin plus antiplatelet agent group ( P Conclusions— The incidence of bleeding events during antithrombotic therapy in Japan was similar to that reported for Western countries, although the trials used different study designs. Dual antithrombotic therapy was independently related to an increased risk of bleeding events.This publication has 29 references indexed in Scilit:
- Combining Aspirin With Oral Anticoagulant TherapyStroke, 2007
- Primary Prevention of Ischemic StrokeStroke, 2006
- Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trialThe Lancet, 2006
- Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic EventsThe New England Journal of Medicine, 2006
- Avoiding Central Nervous System Bleeding During Antithrombotic TherapyStroke, 2005
- Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trialThe Lancet, 2004
- Trends in the Incidence, Mortality, and Survival Rate of Cardiovascular Disease in a Japanese CommunityStroke, 2003
- Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patientsBMJ, 2002
- Optimal Intensity of International Normalized Ratio in Warfarin Therapy for Secondary Prevention of Stroke in Patients with Non-valvular Atrial Fibrillation.Internal Medicine, 2001
- Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor strokeThe Lancet, 1993