Comparison of Long-Term Outcomes Between Combination Antiplatelet and Anticoagulant Therapy and Anticoagulant Monotherapy in Patients With Atrial Fibrillation and Left Atrial Thrombi
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- Sunaga Akihiro
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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- Hikoso Shungo
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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- Nakatani Daisaku
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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- Inoue Koichi
- Cardiovascular Center, Sakurabashi Watanabe Hospital
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- Okuyama Yuji
- Cardiovascular Division, Osaka Minami Medical Center
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- Egami Yasuyuki
- Division of Cardiology, Osaka Rosai Hospital
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- Kashiwase Kazunori
- Cardiovascular Division, Osaka Minami Medical Center Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
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- Hirata Akio
- Cardiovascular Division, Osaka Police Hospital
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- Masuda Masaharu
- Cardiovascular Center, Kansai Rosai Hospital
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- Furukawa Yoshio
- Division of Cardiology, Osaka General Medical Center
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- Watanabe Tetsuya
- Division of Cardiology, Osaka General Medical Center
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- Mizuno Hiroya
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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- Okada Katsuki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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- Dohi Tomoharu
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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- Kitamura Tetsuhisa
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
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- Komukai Sho
- Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine
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- Kurakami Hiroyuki
- Department of Medical Innovation, Osaka University Hospital
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- Yamada Tomomi
- Department of Medical Innovation, Osaka University Hospital
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- Takeda Toshihiro
- Department of Medical Informatics, Osaka University Graduate School of Medicine
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- Kida Hirota
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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- Oeun Bolrathanak
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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- Kojima Takayuki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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- Minamiguchi Hitoshi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Cardiovascular Division, Osaka Police Hospital
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- Sakata Yasushi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Abstract
<p>Background:Anticoagulation for patients with atrial fibrillation (AF) complicated by left atrial thrombi (LAT) is a frequent cause of bleeding complications, but risk factors remain unknown.</p><p>Methods and Results:Of 3,139 AF patients who underwent transesophageal echocardiography, 82 with LAT under anticoagulation were included in this study. Patients treated with combination antiplatelet and anticoagulant therapy (n=31) were compared with those receiving anticoagulant monotherapy (n=51) to investigate the effects of antiplatelet agents during anticoagulation on bleeding complications. Over a mean (±SD) follow-up of 878±486 days, bleeding events occurred more frequently in the combination therapy than monotherapy group (58% vs. 20%; P<0.001), but there was no significant difference in embolic events (6.5% vs. 3.9%; P=0.606). Kaplan-Meier analysis also showed a significantly higher rate of bleeding events in the combination therapy group, but no significant difference in the rate of embolic events. Inverse probability of treatment weighting revealed that combination therapy was independently associated with an increased risk of bleeding (hazard ratio [HR] 2.98, 95% confidence interval [CI] 1.14–7.89, P=0.026), but not with the risk of embolic events (HR 0.30, 95% CI 0.04–2.59, P=0.275). Net clinical benefit analysis was almost negative for combination therapy vs. monotherapy.</p><p>Conclusions:In patients with AF and LAT, combination therapy was significantly associated with an increased risk of bleeding events, but not with a reduced risk of embolic events.</p>
Journal
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- Circulation Reports
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Circulation Reports 2 (9), 457-465, 2020-09-10
The Japanese Circulation Society
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Keywords
Details 詳細情報について
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- CRID
- 1390848647545989632
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- NII Article ID
- 130007899928
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- ISSN
- 24340790
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- Text Lang
- en
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- Data Source
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- JaLC
- Crossref
- CiNii Articles
- KAKEN
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- Abstract License Flag
- Disallowed