#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

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
prolekare.web.journal.doi_sk: https://doi.org/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:

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


Zdroje

1. Kalaitzakis E, Rosengren A, Skommevik T, Björnsson E. Coronary artery disease in patients with liver cirrhosis. Dig Dis Sci 2010;55:465–75.

2. Møller S, Bernardi M. Interactions of the heart and liver. Eur Heart J 2013;34:2804–11. doi: 10.1093/eurheartj/eht246 23853073

3. Raval Z, Harinstein ME, Skaro AI, Erdogan A, DeWolf AM, Shah SJ, et al. Cardiovascular risk assessment of the liver transplant candidate. J Am Coll Cardiol 2011;58:223–31. doi: 10.1016/j.jacc.2011.03.026 21737011

4. Azarbal B1, Poommipanit P, Arbit B, Hage A, Patel J, Kittleson M, et al. Feasibility and safety of percutaneous coronary intervention in patients with end-stage liver disease referred for liver transplantation. Liver Transpl 2011;17:809–13. doi: 10.1002/lt.22301 21425429

5. Russo MW, Pierson J, Narang T, Montegudo A, Eskind L, Gulati S. Coronary artery stents and antiplatelet therapy in patients with cirrhosis. J Clin Gastroenterol 2012;46:339–44. doi: 10.1097/MCG.0b013e3182371258 22105182

6. Krill T, Brown G, Weideman RA, Cipher DJ, Spechler SJ, Brilakis E, et al. Patients with cirrhosis who have coronary artery disease treated with cardiac stents have high rates of gastrointestinal bleeding, but no increased mortality. Aliment Pharmacol Ther 2017;46:183–92. doi: 10.1111/apt.14121 28488370

7. Cheng CL, Lee CH, Chen PS, Li YH, Lin SJ, Yang YH. Validation of acute myocardial infarction cases in the national health insurance research database in Taiwan. J Epidemiol 2014.

8. Lin YT, Wu PH, Lin CY, Lin MY, Chuang HY, Huang JF, et al. Cirrhosis as a risk factor for tuberculosis infection—a nationwide longitudinal study in Taiwan. Am J Epidemiol 2014;180:103–10. doi: 10.1093/aje/kwu095 24829509

9. Chen CC, Chen SW, Tu PH, Huang YC, Liu ZH, Yi-Chou Wang A, et al. Outcomes of chronic subdural hematoma in patients with liver cirrhosis. J Neurosurg. 2018;130:302–11. doi: 10.3171/2017.8.JNS171103 29393757

10. Tsai TT, Messenger JC, Brennan JM, Patel UD, Dai D, Piana RN, et al. Safety and efficacy of drug-eluting stents in older patients with chronic kidney disease: A report from the linked CathPCI Registry-CMS claims database. J Am Coll Cardiol 2011;58:1859–1869. doi: 10.1016/j.jacc.2011.06.056 22018296

11. Wu CY, Chen YJ, Ho HJ, Hsu YC, Kuo KN, Wu MS, et al. Association between nucleoside analogues and risk of hepatitis B virus-related hepatocellular carcinoma recurrence following liver resection. JAMA 2012;308:1906–14. doi: 10.1001/2012.jama.11975 23162861

12. Cheng CL, Lee CH, Chen PS, Li YH, Lin SJ, et al. Validation of acute myocardial infarction cases in the national health insurance research database in Taiwan. J Epidemiol 2014;24:500–7. doi: 10.2188/jea.JE20140076 25174915

13. Chang SH, Chou IJ, Yeh YH, Chiou MJ, Wen MS, Kuo CT, et al. Association between use of non–vitamin K oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrillation. JAMA 2017;318:1250–9. doi: 10.1001/jama.2017.13883 28973247

14. Wang YP, Chen YT, Tsai CF, Li SY, Luo JC, Wang SJ, et al. Short-term use of serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding. Am J Psychiatry 2014;171:54–61. doi: 10.1176/appi.ajp.2013.12111467 24030313

15. Elze MC, Gregson J, Baber U, Williamson E, Sartori S, Mehran R, et al. Comparison of propensity score methods and covariate adjustment: evaluation in 4 cardiovascular studies. J Am Coll Cardiol 2017;69:345–57. doi: 10.1016/j.jacc.2016.10.060 28104076

16. Wu VC, Chen SW, Ting PC, Chang CH, Wu M, Lin MS, et al. Selection of β-Blocker in Patients With Cirrhosis and Acute Myocardial Infarction: A 13-Year Nationwide Population-Based Study in Asia. J Am Heart Assoc 2018;7:e008982 doi: 10.1161/JAHA.118.008982 30371327

17. Chen CC, Chen SW, Tu PH, Huang YC, Liu ZH, Wang AY, et al. Outcomes of chronic subdural hematoma in patients with liver cirrhosis. J Neurosurg 2018;130:302–11 doi: 10.3171/2017.8.JNS171103 29393757


Článok vyšiel v časopise

PLOS One


2019 Číslo 10
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Kurzy

Zvýšte si kvalifikáciu online z pohodlia domova

Aktuální možnosti diagnostiky a léčby litiáz
nový kurz
Autori: MUDr. Tomáš Ürge, PhD.

Všetky kurzy
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#