Critical Appraisal of Guidelines for Antithrombotic Therapy in Atrial Fibrillation Post-Percutaneous Coronary Intervention.

Yongqiang Fan,Xinxue Liao,Shaozhao Zhang,Yifen Lin,Gaoxing Zhang,Xiaodong Zhuang,Xiangbin Zhong,Yiquan Huang,Menghui Lin,Zhengzhipeng Zhang

doi:10.5334/gh.1104

Abstract

Objective:In our present study, our objective was to appraise guidelines on antithrombotic therapy in atrial fibrillation post-percutaneous coronary intervention and to explore the differences in treatment practices for better informed decision-making.Methods:We searched for English language guidelines published between January 2000 and December 2020 at MEDLINE, Embase and websites of guideline organizations. Guidelines with recommendations on antithrombotic regimens for patients with AF undergoing PCI were included. Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument was applied to assess guidelines. The reporting of conflicts of interest (COI) was evaluated separately by the RIGHT (Reporting Item for Practice Guidelines in Healthcare) checklist as supplementary items.Results:Sixteen guidelines were included, among which 13 (81.25%) were considered as ‘recommended’ and 1 (6.25%) as ‘unrecommended.’ The average scores of guidelines ranged from 55% to 88% (<60% as low quality, 60–70% as sufficient quality, and >70% as good quality). Among the 6 domains of AGREE II, scope and purpose (84%) and editorial independence(87%) were considered to be the fields in which CPGs performed best, evidenced by the highest mean AGREE II scores. The domains in which the reviewed CPGs received the lowest mean scores were stakeholder involvement (63%) and applicability (58%). The intraclass correlation coefficient scores were excellent in each domain. The overall quality of the selected CPGs was optimal, with the highest score in domain ‘scope and purpose’, and the lowest score in the domain ‘applicability.’ The reporting of COI was satisfactory.Conclusions:For the recommendations on antithrombotic strategies, guidelines with high AGREE II scores still exist discrepancy on the timing and selection. Current guidance documents on the treatment vary in methodological rigor and recommendations are not always consistent.

Highlights

Dual antiplatelet therapy is confirmed to reduce the incidence of recurrent ischemic events and stent thrombosis but is less effective in reducing the impact of cardioembolic stroke associated with atrial fibrillation [4]
There were more than 10 antithrombosis-relevant clinical practice guidelines (CPGs) published over the past two decades
Supplementary guidelines were available by searching websites of guideline organizations Criteria for selection were as follows: (a) follow the definition of CPGs [6]: systematically develop statements to assist physicians and patients in determining appropriate medical care for specific clinical situations; (b) target groups included patients with Atrial fibrillation (AF) and percutaneous coronary intervention (PCI); (c) contain recommendations on antithrombotic therapy for target patients; (d) are published in English

Summary

Introduction

Oral anticoagulation has been used as the first choice to prevent stroke and systemic embolism in patients with AF but has not been proved to avert stent thrombosis [3]. Dual antiplatelet therapy is confirmed to reduce the incidence of recurrent ischemic events and stent thrombosis but is less effective in reducing the impact of cardioembolic stroke associated with atrial fibrillation [4]. When AF patients encounter PCI, the relationship between anticoagulation and antiplatelet treatment should be balanced. Choosing antithrombotic therapy for patients with atrial fibrillation who have undergone PCI is challenging. There were more than 10 antithrombosis-relevant clinical practice guidelines (CPGs) published over the past two decades. We examined the availability, consistency and quality of CPGs for individuals who underwent PCI and AF.

Methods

Results

Discussion

Conclusion