PloS one, 2019-10, Vol.14 (10), p.e0223380-e0223380
2019
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- Autor(en) / Beteiligte
- Titel
- Dual antiplatelet therapy in patients with cirrhosis and acute myocardial infarction - A 13-year nationwide cohort study
- Ist Teil von
- PloS one, 2019-10, Vol.14 (10), p.e0223380-e0223380
- Ort / Verlag
- United States: Public Library of Science
- Erscheinungsjahr
- 2019
- Quelle
- MEDLINE
- Beschreibungen/Notizen
- Patients with cirrhosis and acute myocardial infarction (AMI) present dilemma whether dual antiplatelet therapy (DAPT) should be used. 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. 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). In cirrhotic patients with AMI, DAPT offers benefit with decreased recurrent MI at the expense of increased gastrointestinal bleeding.
- Sprache
- Englisch
- Identifikatoren
- ISSN: 1932-6203eISSN: 1932-6203DOI: 10.1371/journal.pone.0223380Titel-ID: cdi_plos_journals_2300607881
- Format
- –
- Schlagworte
- Anesthesiology, Anticoagulants, Antiplatelet therapy, Autoimmune diseases, Biology and Life Sciences, Bleeding, Cardiac patients, Cardiology, Cardiovascular disease, Care and treatment, Cerebral infarction, Chronic illnesses, Cirrhosis, Clinical Decision-Making, Clopidogrel, Cohort analysis, Congestive heart failure, Coronary vessels, Disease Management, Dual Anti-Platelet Therapy - adverse effects, Dual Anti-Platelet Therapy - methods, Electronic health records, Electronic medical records, Female, Gastrointestinal hemorrhage, Gastrointestinal Hemorrhage - diagnosis, Gastrointestinal Hemorrhage - epidemiology, Gastrointestinal Hemorrhage - etiology, Health, Health insurance, Heart, Heart attack, Heart attacks, Heart failure, Hospitals, Humans, Insurance, Intervention, Ischemia, Liver, Liver cirrhosis, Liver Cirrhosis - blood, Liver Cirrhosis - complications, Liver Cirrhosis - epidemiology, Liver diseases, Liver transplantation, Liver transplants, Medical records, Medical research, Medicine and Health Sciences, Mortality, Myocardial infarction, Myocardial Infarction - blood, Myocardial Infarction - complications, Myocardial Infarction - drug therapy, Myocardial Infarction - epidemiology, National health insurance, Organ transplantation, Outpatient care facilities, People and Places, Percutaneous Coronary Intervention - adverse effects, Percutaneous Coronary Intervention - methods, Platelet aggregation inhibitors, Platelet Aggregation Inhibitors - adverse effects, Platelet Aggregation Inhibitors - therapeutic use, Prognosis, Public Health Surveillance, Recurrence, Stroke, Technology application, Therapy, Transplants & implants, Treatment Outcome