Dual antiplatelet therapy in patients with cirrhosis and acute myocardial infarction – A 13-year nationwide cohort study


Autoři: Victor Chien-Chia Wu aff001;  Shao-Wei Chen aff002;  An-Hsun Chou aff003;  Pei-Chi Ting aff003;  Chih-Hsiang Chang aff004;  Michael Wu aff005;  Ming-Jer Hsieh aff001;  Chao-Yung Wang aff001;  Shang-Hung Chang aff001;  Ming-Shyan Lin aff006;  Kuo-Chun Hung aff001;  I-Chang Hsieh aff001;  Pao-Hsien Chu aff001;  Cheng-Shyong Wu aff007;  Yu-Sheng Lin aff006
Působiště autorů: Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan aff001;  Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan aff002;  Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan aff003;  Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan aff004;  Divison of Cardiovascular Medicine, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, United States America aff005;  Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan aff006;  Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223380

Souhrn

Background

Patients with cirrhosis and acute myocardial infarction (AMI) present dilemma whether dual antiplatelet therapy (DAPT) should be used.

Methods

Electronic medical records between 2001–2013 were retrieved from Taiwan National Health Insurance Research Database. Patients were excluded for missing information, age <20 years old, history of AMI, liver transplant, autoimmune disease, coagulopathy, taking DAPT 3 months before index date, follow-up <3 months, anticoagulation user, without DAPT, and events of myocardial infarction (MI), ischemic stroke, major bleeding, and heart failure within 3-month of enrollment. Primary outcomes were 1-year all-cause mortality, recurrent MI, major bleeding, and gastrointestinal bleeding.

Results

A total of 150,887 patients with AMI retrieved. After exclusion criteria and propensity score-matching, 914 cirrhotic and 3,656 non-cirrhotic patients with AMI on DAPT were studied. During 1-year follow-up, there was significantly increased mortality in cirrhotic patients compared to non-cirrhotic patients (HR = 1.49, 95% CI = 1.28–1.74). There was significantly decreased recurrent MI in cirrhotic patients compared to non-cirrhotic patients (subdistribution HR [SHR] = 0.71, 95% CI = 0.54–0.92). However, non-significantly increased major bleeding (SHR = 1.23, 95% CI = 0.87–1.73) and significantly increased gastrointestinal bleeding (SHR = 1.49, 95% CI = 1.31–1.70).

Conclusions

In cirrhotic patients with AMI, DAPT offers benefit with decreased recurrent MI at the expense of increased gastrointestinal bleeding.

Klíčová slova:

Antiplatelet therapy – Cirrhosis – Coronary heart disease – Death rates – Hemorrhage – Liver transplantation – Myocardial infarction – Taiwan


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PLOS One


2019 Číslo 10

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