Abstract

Background: There is limited data evaluating the prescription practices for antithrombotic therapy in patients with atrial fibrillation (AF) following elective percutaneous coronary intervention (PCI).Objective: This single-center, single-operator, retrospective cohort study aimed to evaluate trends of antithrombotic treatment strategies in patients with AF undergoing elective PCI.Methods: Patients with AF who electively underwent PCI performed by a single interventionalist between April 2013 and May 2018 were identified. The primary outcome was the antithrombotic therapy at discharge assessed by chart review: triple (TAT, triple antithrombotic therapy) or dual (DAT, dual antithrombotic therapy) antithrombotic therapy and vitamin K antagonist (VKA) or non-vitamin K antagonist oral anticoagulant (NOAC), respectively.Results: Of 6,135 screened patients, 259 met the inclusion criteria. Among these, 133 (51%) patients received NOAC- and 126 (49%) VKA-therapy. Compared with patients on NOAC therapy, patients treated with VKA had higher bleeding risk (mean HAS-BLED-Score; 2.3 vs. 2.0; p = 0.02) and more co-morbidities (estimated glomerular filtration rate <30 ml/min, 11 vs. 4%; p = 0.04; diabetes mellitus, 33 vs. 20%; p = 0.03; history of previous PCI, 37 vs. 21%; p < 0.01). TAT was prescribed more frequently if the prescription included VKA compared with NOAC (61 vs. 41%; p < 0.01). Prescription of TAT and VKA decreased throughout the observed period (2013: 100% vs. 2018: 6%; p < 0.01 and 2013: 91% vs. 2018: 28%; p < 0.01).Conclusion: These observational data from a single center registry show a decrease of TAT- and VKA- prescription in favor of DAT with NOAC. Whether these observations are consistent with national or global trends should to be evaluated in further studies.

Highlights

  • Atrial fibrillation (AF) increases the risk of stroke, embolization, and death [1]

  • Of 6,135 patients hospitalized for elective coronary angiography between 04/2013 and 05/2018, 259 (4.2%) were patients with AF under vitamin K antagonist (VKA) or Non-vitamin an antagonist oral anticoagulant (NOAC) therapy that underwent percutaneous coronary intervention (PCI) with additional anti-platelet therapy after discharge

  • Compared with patients on NOAC therapy, patients prescribed with VKA had a higher bleeding risk profile and more co-morbidities

Read more

Summary

Introduction

Atrial fibrillation (AF) increases the risk of stroke, embolization, and death [1]. Oral anticoagulation (OAC) reduces this risk up to two-thirds irrespective of baseline risk [2]. Non-vitamin K antagonist oral anticoagulants (NOACs) are safer and effective compared with vitamin K antagonist (VKA) [3]. The antithrombotic treatment of patients with AF undergoing elective percutaneous coronary intervention (PCI) poses a dilemma. Guidelines recommend acetylsalicylic acid (ASA) and clopidogrel following the placement of a coronary artery stent to an established OAC therapy, NOAC or VKA respectively forming a triple antithrombotic therapy (TAT) [4]. There is limited data evaluating the prescription practices for antithrombotic therapy in patients with atrial fibrillation (AF) following elective percutaneous coronary intervention (PCI)

Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call