What is the optimal antithrombotic therapy of atrial fibrillation patients after coronary artery stent deployment?

Abstract

Purpose: Although the antithrombotic regimen in the Atrial Fibrillation (AF) patients after coronary artery stent deployment is controversy, the relationship between actual antithrombotic therapy in the late phase of stenting and their clinical course has never been studied. The purpose of this study was to clarify the prognosis and complications of the AF patients after coronary artery stenting, and determine the most suitable antithrombotic regimen for Japanese patients, whose stroke risks are higher than European. Methods and results: We studied 131 patients (mean age 70.7±7.5, 73.3% male, 51.9% using drug eluting stents) who underwent coronary artery stent deployment from October 2004 to September 2011. During a median follow-up of 47 months, all cause death, major adverse cardiac events (MACE; i.e. death, non-fatal myocardial infarction, target revascularization), Cerebral Infarction (CI), and major bleeding requiring hospitalization were observed in 29 (22.1%), 53 (40.5%), 12 (9.2%), and 17 (13.0%) patients, respectively. The incidence of major bleeding is higher in patients continued both dual antiplatelet therapy (DAPT) and warfarin after 12 months of stenting than those discontinued DAPT and/or warfarin (p=0.0001). The incidence of CI tended to be higher in patients who discontinued warfarin after 12 months of stenting than those continued (12.5% vs. 5.1%, p=0.143), whereas there was no significant difference in the rate of MACE (43.1% vs. 37.3%, p=0.503). ![Figure][1] Cumulative rate of major bleeding Conclusions: The prognosis of AF patients after coronary artery stenting is poor as a whole. As described in the guideline of European Society of Cardiology, Vitamin K Antagonist (VKA) is needed for the prevention of CI, and prolonged use of combined antithrombotic agents increases the risk of major bleeding. [1]: pending:yes