Abstract
BackgroundThe management of atrial fibrillation and flutter (AF) patients undergoing percutaneous coronary intervention (PCI) has undergone a rapid recent evolution. In 2016, the Canadian Cardiovascular Society (CCS) published expert recommendations to help guide clinicians in balancing bleeding and thrombotic risks in these patients.HypothesisAntithrombotic regimen prescriptions for AF patients undergoing PCI evolved after the publication of the 2016 CCS AF guidelines.MethodsA prospective cohort of AF patients undergoing PCI with placement of a coronary stent from a single tertiary academic center was analyzed for the recommended antithrombotic regimen at discharge. Prescribing behavior was compared between three time periods (Cohort A [2010‐2011]; Cohort B [2014‐2015]; Cohort C [2017]) using the χ 2 test. In addition, antithrombotic management in Cohorts B and C were compared to guideline‐recommended therapy.ResultsA total of 459 patients with AF undergoing PCI were identified. Clinical and procedural characteristics were similar between cohorts, with the exception of an increase in drug‐eluting stent (DES) use over time (P < .01). Overall, the rate of oral anticoagulation (OAC) increased over time (P < .01), associated with an increase in nonvitamin K OAC prescription (P < .01) and a concomitant decrease in vitamin K antagonist prescription (P < .01). Despite this, the overall rate of anticoagulation remains below what would be predicted with perfect guideline compliance (75% vs 94%, P < .01).ConclusionThere has been a dramatic shift in clinical practice for AF patients requiring PCI, with increases in prescription of OAC even in the context of an increase in the use of DES. However, room for further practice optimization still exists.
Highlights
Contemporary antithrombotic management of patients with either atrial fibrillation/flutter (AF) or coronary artery disease (CAD) has largely been well defined in clinical guidelines.[1,2,3,4] up to 30% of patients with AF have CAD5 and the optimal management of AF patients requiring percutaneous coronary intervention (PCI) has, up until recently, been less clear
There has been a dramatic shift in clinical practice for AF patients requiring PCI, with increases in prescription of oral anticoagulation (OAC) even in the context of an increase in the use of drug-eluting stent (DES)
The landmark PIONEER AF-PCI10 was published in 2016, followed closely by REDUAL11 and AUGUSTUS,[12] providing further evidence in support of nonvitamin K oral anticoagulation (NOAC)-based antithrombotic regimens that could minimize the bleeding risk in AF patients having benefitted from PCI
Summary
Contemporary antithrombotic management of patients with either atrial fibrillation/flutter (AF) or coronary artery disease (CAD) has largely been well defined in clinical guidelines.[1,2,3,4] up to 30% of patients with AF have CAD5 and the optimal management of AF patients requiring percutaneous coronary intervention (PCI) has, up until recently, been less clear. In 2016, both the Canadian Cardiovascular Society (CCS) and European Society of Cardiology (ESC) published expert recommendations to help guide clinicians in balancing bleeding and thrombotic risks in these patients.[1,3] The landmark PIONEER AF-PCI10 was published in 2016, followed closely by REDUAL11 and AUGUSTUS,[12] providing further evidence in support of nonvitamin K oral anticoagulation (NOAC)-based antithrombotic regimens that could minimize the bleeding risk in AF patients having benefitted from PCI. The management of atrial fibrillation and flutter (AF) patients undergoing percutaneous coronary intervention (PCI) has undergone a rapid recent evolution. Methods: A prospective cohort of AF patients undergoing PCI with placement of a coronary stent from a single tertiary academic center was analyzed for the recommended antithrombotic regimen at discharge. The overall rate of anticoagulation remains below what would be predicted with perfect guideline compliance (75% vs 94%, P < .01)
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