Objective To investigate the application of antithrombotic therapy and analyze the effect of
the antithrombotic treatment with parenteral anticoagulation and dual antiplatelet therapy (DT;
aspirin+clopidogrel/ticagrelor) in hospitalized patients with acute myocardial infarction (AMI) and
non-valvular atrial fibrillation (NVAF) retrospectively.
Methods A total of 143 hospitalized patients who was admitted with AMI and diagnosed with
NVAF within 1 month before admission between Jan 2010 and Dec 2015 in Department of
Neurology of Beijing Anzhen Hospital were included in this study. The antithrombotic therapy
information during hospitalization period and on discharge were investigated. Patients recevied DT
during hospitalization period were divided into DT group (n =33) while patients recevied parenteral
anticoagulation combined with DT were divided into TT group (triple antithrombotic therapy,
n =102). The bleeding events according to the bleeding academic research criteria (BARC) and
ischemic events (ie, ischemic stroke, recurrent acute coronary artery syndrome, peripheral arterial embolization) were compared between the two groups.
Results ①Only 12.6% (18/143) of these 143 selected patients with NVAF were taking warfarin
before their AMI admission. During hospitalization period, 71.3% (102/143) of those received
parenteral anticoagulation combined with DT and there were some patients who didn’t receive any
anticoagulant therapy, among which, DT accounted for 23.1% (33/143), and single antiplatelet therapy
(ST; aspirin/clopidogrel/ticagrelor) accounted for 2.1% (3/143). On discharge, more than 2/3 patients
received DT, accounting for 76.9% (103/134), and only 4.5% (6/134) received warfarin combined
with DT. ②During hospitalization period, the rate of total bleeding events (BARC 2-5), major
bleeding events (BARC 3, 5) and minor bleeding events (BARC 2) were lower (3.0% vs 7.8%, 0 vs
1.0%, 3.0% vs 6.9%), however, the rate of total ischemic events, ischemic stroke, peripheral arterial
embolism rate were higher (6.1% vs 3.9%, 6.1% vs 1.0%, 3.0% vs 0) in DT group compared with TT
group, while there was no significant difference between the two groups (P >0.05).
Conclusion This study suggests that there are some patients who don’t received any anticoagulant
therapy, and the parenteral anticoagulation combined with dual antiplatelet therapy does
not significantly reduce the thrombotic events and increase the hemorrhagic events during
hospitalization in patients with AMI and NVAF. What’s more, the proportion of the triple
antithrombotic therapy as secondary prevention is very low in patients with AMI and NVAF.
