DISCUSSION
bleeding, death, cardiovascular death, stroke, thrombocytopenia, acute coronary syndrome, Bleeding, diabetes
BLEEDING, MYOCARDIAL INFARCTION, STROKE, THROMBOCYTOPENIA, EVENT, ADVERSE EFFECT, ACUTE CORONARY SYNDROME, BLEEDING, EVENTS, HEART FAILURE, DIABETES
The major findings of this study demonstrated that the presence of baseline thrombocytopenia was significantly associated with an increased risk of major bleeding in the chronic phase. Moreover, even if a patient with AF with CCS is comorbid with thrombocytopenia, an appropriate antithrombotic drug could reduce major bleeding.The BARC (Bleeding Academic Research Consortium) provided a standardized definition of bleeding end point for coronary stent trials, and baseline moderate and severe thrombocytopenia is considered 1 of 12 major high bleeding risk criteria.Moreover, the study population included patients with AF with CCS in the chronic phase but not patients with acute coronary syndrome. Although the relationship between acquired acute thrombocytopenia and short‐term outcomes among patients with acute coronary syndrome was reported, it seems to be a temporary adverse effect because acquired acute thrombocytopenia may be associated with the use of unfractionated heparin, furosemide, nonsteroidal anti‐inflammatory drugs, and some antibiotics.Conversely, thrombocytopenia in this study may reflect a greater degree of comorbidities, including the elderly as well as high incidences of diabetes and heart failure. This study demonstrated that patients with AF with thrombocytopenia were associated with an increased risk of all‐cause mortality or a composite risk of cardiovascular death, myocardial infarction, or stroke compared with those without thrombocytopenia. The relationship between thrombocytopenia and ischemic events is still unclear, but several mechanisms would be involved, including patient vulnerability. An alternative explanation is that major bleeding and the onset of ischemic events are closely related. This study showed that the event curve of MACE among patients with AF with thrombocytopenia was increasing after ≈2 years following enrollment, and the timing was after major bleeding occurred. This finding is consistent with another subanalysis of the AFIRE trial, wherein patients with AF with CCS were more likely to have a major bleeding followed by a cardiovascular event or death. In a previous study, the risk of ischemic events increased nearly 8‐fold within 30 days after the development of major bleeding.