Characteristics and outcomes in patients with atrial fibrillation and acute coronary syndrome treated with ticagrelor and novel oral anticoagulants

• Published in: Thrombosis update Vol. 3; p. 100054
• Main Authors: van der Pals, Jesper, Holmqvist, Fredrik, Borgquist, Rasmus, Götberg, Matthias, Nseir, Mohaned, Koul, Sasha, Isma, Nazim, Scherstén, Fredrik, Tydén, Patrik, Braun, Oscar Ö., Erlinge, David
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.05.2021; Elsevier
• Subjects: Acute coronary syndrome; Antithrombotic therapy; Cardiology and Cardiovascular Disease; Clinical Medicine; Hematology, Oncology, and Palliative Medicine; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Novel oral anticoagulants; Ticagrelor; Antithrombotic therapy; Acute coronary syndrome; Ticagrelor; Novel oral anticoagulants
• ISSN: 2666-5727; 2666-5727
• DOI: 10.1016/j.tru.2021.100054

Optimal antithrombotic treatment after an acute coronary syndrome (ACS) in patients with atrial fibrillation is unclear. Data on outcomes in patients on concomitant ticagrelor and the novel oral anticoagulants (NOAC) is scarce. This study therefore sought to describe patient characteristics and treatment outcomes in patients with atrial fibrillation and ACS treated with concomitant ticagrelor and NOACs (double antithrombotic therapy, DT). We retrospectively identified all ACS patients with atrial fibrillation on DT upon discharge from Skåne University Hospital in Lund, Sweden, between 2016 and 2019. Identified patients were compared with age and sex matched controls with ACS alone treated with ticagrelor and aspirin (DAPT). Major bleeding was defined in accordance with the HAS-BLED derivation study. Patients were retrospectively followed for six months. In total, 341 patients on DT were identified and compared with 341 controls on DAPT. Mean HAS-BLED bleeding risk score was higher in patients on DT (2.9 ± 1.0 vs 2.6+/0.9 units, p < 0.001; DT vs DAPT). The incidence of major bleeding was higher in patients on DT (31 (9.1%) vs 10 (2.9%), p = 0.001; DT vs DAPT), while a composite of all thrombotic events was found to be similar between the groups (8 (2.3%) vs 5 (1.5%), p = NS; DT vs DAPT). While thrombotic events occur at a similar rate, the bleeding rate is higher in patients with atrial fibrillation and ACS treated with DT than in patients with ACS alone treated with DAPT. Patients with atrial fibrillation also have a higher basal bleeding risk. •Largest population ever published on outcomes in patients on concomitant ticagrelor and novel oral anticoagulants.•Based on 5110 consecutive patients treated over 3.5 years compared to age and sex matched controls.•Outcomes on major bleeding according to the HASBLED definition.•Outcomes on thrombotic events.•Provides guidance to clinical decision making on antithrombotic regimen in patients with atrial fibrillation after an acute coronary syndrome.