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Wada H, Miyauchi KM, Yasuda SY, Kaikita KK, Akao MA, Ako JA, Matoba TM, Nakamura MN, Hagiwara NH, Kimura KK, Hirayama AH, Matsui K, Ogawa HO. Antithrombotic and proton pump inhibitor co-therapy in patients with atrial fibrillation and stable coronary disease: a post hoc analysis of the AFIRE trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Among patients with atrial fibrillation (AF) and stable coronary artery disease, bleeding events increased the cardiovascular events and mortality. We aimed to evaluate the effect of proton pump inhibitor (PPI) on the risk of bleeding events in these patients.
Methods
In the AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease), patients with non-valvular AF and coronary artery disease were recruited and randomized to receive the rivaroxaban monotherapy or combination therapy with rivaroxaban plus antiplatelet drug. The present sub-analysis evaluated the risks of any bleeding events.
Results
Among 2,225 patients, 1,357 (61.3%) were receiving a PPI at baseline. During follow-up, 384 bleeding events were occurred, and incidence of bleeding events were significantly lower in patients with PPI compared with those without PPI (p=0.03). Among combination therapy with rivaroxaban plus antiplatelet, effect of PPI for cumulative incidence of bleeding events were significantly different between groups (p=0.01), however, these differences were not shown among rivaroxaban monotherapy patients (p=0.50, Figure 1). Multivariate Cox hazard analysis showed that PPI use had significantly lower risk of bleeding events (hazard risk 0.79, 95% confidence interval 0.64–0.97, p=0.03). In addition to PPI, male, heart failure and combination therapy with rivaroxaban plus antiplatelet drug were independent predictors of bleeding events.
Conclusions
PPI use was significantly associated with lower risk of bleeding events among patients with AF and stable coronary artery disease. Especially, for patients at high bleeding risk, such as receiving both anticoagulant and antiplatelet drugs, PPI is useful to reduce bleeding events.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The Japan Cardiovascular Foundation through a contract with Bayer Yakuhin.
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Affiliation(s)
- H Wada
- Juntendo University Shizuoka Hospital , Izunokuni , Japan
| | - K M Miyauchi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Medicine , Tokyo , Japan
| | | | | | - M A Akao
- National Hospital Organization Kyoto Medical Center , Kyoto , Japan
| | - J A Ako
- Kitasato University School of Medicine , Sagamihara , Japan
| | | | - M N Nakamura
- Toho University Ohashi Medical Center , Tokyo , Japan
| | - N H Hagiwara
- Tokyo Women's Medical University , Tokyo , Japan
| | - K K Kimura
- Yokohama City University Medical Center , Yokohama , Japan
| | | | - K Matsui
- Kumamoto University , Kumamoto , Japan
| | - H O Ogawa
- National Cerebral & Cardiovascular Center , Suita , Japan
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Utsunomiya M, Takahara MT, Fujihara MF, Shiraki TS, Kozuki AK, Fukunaga TF, Tan MT, Yoshioka YR, Tomoi TY, Mori SM, Iwasaki YI, Sasaki SS, Nakamura MN. P3567Long term usefulness of target lesion revascularization for asymptomatic restenosis of superficial femoral artery after endovascular therapy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Utsunomiya
- Tokyo Rosai Hospital, Cardiovascular Medicine, Tokyo, Japan
| | - M T Takahara
- Osaka University Graduate School of Medicine, Department of diabetes care medicine and Department of metabolic medicine, Osaka, Japan
| | | | | | - A K Kozuki
- Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | | | - M T Tan
- Tokeidai Memorial Hospital, Sapporo, Japan
| | - Y R Yoshioka
- The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - T Y Tomoi
- Kokura Memorial Hospital, Kokura, Japan
| | - S M Mori
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | | | | | - M N Nakamura
- Toho University Ohashi Medical Center, Cardiology, Tokyo, Japan
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