Treatment Pattern of Antithrombotic Therapy over Time after Percutaneous Coronary Intervention in Patients with Atrial Fibrillation in Real-World Practice in Korea.

Seongwook Han,Young-Hoon Kim,Myung-Yong Lee,Sung-Won Jang,Ji-Min Lee,Oh Young Bang,Ji-Soo Shin,Yoo-Jung Park,Hae Sun Suh,Seongsik Kang,Sola Han,Young-Keun On

doi:10.3390/healthcare9091185

Abstract

We examined antithrombotic treatment patterns with clinical characteristics and therapy changes over time in patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). Using the Health Insurance Review and Assessment service claims database (01JAN2007-30NOV2016) in Korea, we included adult patients with AF and PCI: (1) who underwent PCI with stenting between 01JAN2008 and 30NOV2016; (2) with ≥1 claim for AF (ICD code: I48) (3) with antithrombotics 1 day prior to or at the date of PCI; and (4) with CHADS2-VASc of ≥2. In this study, 7749 patients with AF who underwent PCI, triple therapy, dual therapy, dual antiplatelet therapy (DAPT), and single antiplatelet therapy were prescribed to 24.6%, 3.4%, 60.8%, and 11.0%, respectively. In the triple therapy group, 23.1% persisted with triple therapy for 12 months, whereas the remaining patients switched to a different therapy. In the entire cohort and several subgroups, the median treatment duration of triple therapy was 55–87 days. DAPT use for 12 months was the most common treatment pattern (62.6%) in the DAPT group (median treatment duration, 324–345 days). A significant discrepancy exists between the current guidelines and real-world practice regarding antithrombotic treatment with PCI for patients with AF. Appropriate use of anticoagulants should be emphasized.

Highlights

Atrial fibrillation (AF) is the most common arrhythmia and is complicated by a five-fold increased ischemic stroke risk [1]; therapeutic prevention with oral anticoagulation (OAC) is required [2,3,4]
Within 1 year before the percutaneous coronary intervention (PCI), 143 (1.8%) patients had a history of NOAC use and 1646 (21.2%) patients had a history of warfarin use
Among patients who had a history of NOAC use, 48.3%, 2.1%, 44.8%, 0.0%, and 4.9% of patients had triple therapy, dual therapy, dual antiplatelet therapy (DAPT), OAC monotherapy, and single antiplatelet therapy (SAPT) as the index treatment, respectively

Summary

Introduction

Atrial fibrillation (AF) is the most common arrhythmia and is complicated by a five-fold increased ischemic stroke risk [1]; therapeutic prevention with oral anticoagulation (OAC) is required [2,3,4]. CAD, with the majority of them needing percutaneous coronary intervention (PCI) with or without stenting [5]. As they need dual antiplatelet therapy (DAPT), i.e., the combination of aspirin and a P2Y12 inhibitor, to prevent the risk of stent thrombosis, the treatment combined with OAC and DAPT for these patients can be complicated [6]. Some of the most complicated aspects are the duration of each of the treatment combinations; the right timing of changing the combination; the different characteristics of each anticoagulant and antiplatelet; and the patients’ comorbidities, risk factors of bleeding, and procedural risk factors for stent thrombosis. Several guidelines have been rapidly and continuously updated on this topic based on new evidence [4,6,12,13,14]; the optimal choice of treatment remains challenging in real-world practice

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