Dual antiplatelet therapy in patients with cirrhosis and acute myocardial infarction – A 13-year nationwide cohort study

• DOI: 10.1371/journal.pone.0223380
• Publication Date: 2019-10-03T17:30:17Z
• Authors: Victor Chien-Chia Wu; Shao-Wei Chen; An-Hsun Chou; Pei-Chi Ting; Chih-Hsiang Chang; Michael Wu; Ming-Jer Hsieh; Chao-Yung Wang; Shang-Hung Chang; Ming-Shyan Lin; Kuo-Chun Hung; I-Chang Hsieh; Pao-Hsien Chu; Cheng-Shyong Wu; Yu-Sheng Lin
• Keywords: Liver Cirrhosis; Science; Dual Anti-Platelet Therapy; Q; Clinical Decision-Making; R; Myocardial Infarction; Disease Management; Prognosis; 3. Good health; 03 medical and health sciences; Percutaneous Coronary Intervention; Treatment Outcome; 0302 clinical medicine; Recurrence; Medicine; Humans; Female; Public Health Surveillance; Mortality; Gastrointestinal Hemorrhage; Platelet Aggregation Inhibitors; Research Article

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. 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, events (MI), ischemic stroke, major bleeding, heart failure within 3-month enrollment. Primary outcomes 1-year all-cause mortality, recurrent MI, gastrointestinal bleeding.A total 150,887 patients AMI retrieved. After exclusion criteria propensity score-matching, 914 cirrhotic 3,656 non-cirrhotic on studied. During follow-up, there was significantly increased mortality in compared to (HR = 1.49, 95% CI 1.28-1.74). There decreased MI (subdistribution HR [SHR] 0.71, 0.54-0.92). However, non-significantly bleeding (SHR 1.23, 0.87-1.73) 1.31-1.70).In offers benefit at the expense bleeding.