Dabigatran versus vitamin k antagonist: an observational across-cohort comparison in acute coronary syndrome patients with atrial fibrillation.

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Dabigatran versus vitamin k antagonist: an observational across-cohort comparison in acute coronary syndrome patients with atrial fibrillation.

J Thromb Haemost. 2017 Dec 23;:

Authors: Gaubert M, Resseguier N, Laine M, Bonello L, Camoin-Jau L, Paganelli F

Abstract
BACKGROUND: Dual antithrombotic therapy comprising a vitamin K antagonist (VKA) plus clopidogrel reduces the incidence of major bleeding compared with triple therapy (VKA+clopidogrel+aspirin) in acute coronary syndrome (ACS) patients with atrial fibrillation (AF), with a similar thrombotic risk. The oral thrombin inhibitor dabigatran (150 mg twice a day) showed superiority over VKA in non-valvular AF, but data supporting its use in AF patients presenting with ACS are limited.
OBJECTIVE: We sought to evaluate the efficacy of dabigatran versus VKA in the management of AF patients undergoing percutaneous coronary intervention for an ACS.
METHODS: In this open-label study, 133 consecutive patients received dabigatran plus clopidogrel. Another cohort of 133 patients treated with VKA plus clopidogrel was used as the control group.
RESULTS: After propensity score adjustment, the cumulative incidence of major adverse cardiovascular events over 24 months was higher with dabigatran versus VKA (adjusted hazard ratio: 2.28, 95% confidence interval: 1.46-3.56). Similar rates of major bleeding were found (adjusted hazard ratio: 1.17, 95% confidence interval: 0.46-2.96).
CONCLUSIONS: In AF patients presenting with ACS, replacement of VKA by dabigatran concurrently with clopidogrel is associated with an increased thrombotic risk, without a reduction in major bleeding. This article is protected by copyright. All rights reserved.

PMID: 29274198 [PubMed - as supplied by publisher]

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