Direct Oral Anticoagulants (DOACs)-Based Versus Warfarin-Based Antithrombotic Regimens in Patients with Atrial Fibrillation Underwent Successful Coronary Stenting at Siriraj Hospital

Abstract

Objective: To investigate the 1-year bleeding outcome between direct oral anticoagulants (DOACs)-based regimens and warfarin-based regimens in real-world practice in Thai patients with atrial fibrillation (AF) and significant coronary artery disease (CAD). Materials and Methods: The present study was a retrospective study. The authors reviewed the electronic medical charts of patients treated at the Siriraj Hospital between January 1, 2012 and October 31, 2019. The inclusion criteria were patients with AF and significant CAD that underwent percutaneous coronary intervention (PCI) with a stent and were prescribed or planned to prescribe anticoagulants after the PCI. The primary end point was the International Society on Thrombosis and Hemostasis (ISTH) bleeding during a 1-year follow-up period after successful coronary stenting. The trial assessed for the difference in the bleeding outcome and composite efficacy end point of myocardial infarction, ischemic stroke, and systemic embolism between patients that received warfarin-based regimen and those that received DOACs-based regimen. Results: The prevalence of patients that received additional oral anticoagulation was 5.1% (679/13,306 patients). One hundred seventy patients met the study inclusion and exclusion criteria. The incidence of the primary end point was 9.0% in the warfarin-based regimen compared with 8.1% in the DOACs-based regimen (p=1.000). The incidence of the composite efficacy end point was 8.3% in the warfarin-based regimen compared with 0% in the DOACs-based regimen (p=0.124). Conclusion: In patients with AF and significant CAD that underwent PCI, the use of a DOACs-based regimen had no statistically significant difference in bleeding outcome but associated with lower ischemic endpoint. However, due to the limited study sample size, the study had insufficient power to declare the results statistically significant. Keywords: Coronary artery disease; Atrial fibrillation; DOAC; Warfarin