Clinical Relevance of Anticoagulation and Dual Antiplatelet Therapy to the Outcomes of Patients With Atrial Fibrillation and Recent Percutaneous Coronary Intervention With Stent

Abstract

BackgroundChronic atrial fibrillation (AF), coexisting with a history of recent coronary angioplasty with stent (PCI-S), represents an encoded indication for oral anticoagulation (OAC) with warfarin plus dual antiplatelet therapy (DAPT).MethodsUsing a retrospective cohort study, we determined the respective impacts on cardiovascular outcomes of three different pharmacologic regimens, i.e., triple therapy (TT) with warfarin + clopidogrel and aspirin, dual therapy (DT) with warfarin + clopidogrel or aspirin, and DAPT with clopidogrel + aspirin. Outcomes of interest were all-cause mortality, ischemic cardiac events, ischemic cerebral events, and bleeding events. The inclusion criterion was the coexistence of an indication for OAC (e.g., chronic AF) with an indication for DAPT due to recent PCI-S.ResultsAmong the 98 patients enrolled, 48 (49%), 31 (31.6%), and 19 (19.4%) patients were prescribed TT, DT, and DAPT, respectively. Throughout a mean follow-up of 378 ± 15.7 days, there were no significant differences between the three regimens for all abovementioned outcomes. In particular, the total frequency of major bleeding was similar in the three groups: five cases (10.4%) in TT, one case (3.22%) in DT and no case in DAPT groups (Chi-square test, P = 0.1987).ConclusionsTT, DT and DAPT displayed similar efficacy and safety. Although the superiority of OAC vs. DAPT for stroke prevention in AF patients has been demonstrated by previous randomized trials, a smaller frequency of high thromboembolic risks’ features in DAPT group of the present study may have prevented the observation of a higher incidence of ischemic stroke in this group.

Efficacy and safety of single vs dual antiplatelet therapy in patients on anticoagulation undergoing percutaneous coronary intervention: A systematic review and meta‐analysis

“…Fifteen studies ultimately met our inclusion criteria. Amongst 15 studies included, five were RCTs and 10 were observational . The study characteristics of individual studies are presented in Table .…”

“…Amongst 15 studies included, five were RCTs 11,12,28-30 and 10 were observational. [22][23][24][25][26][27][28][29][30][31] The study characteristics of individual studies are presented in Table 2.…”

Triple or dual antithrombotic therapy post‐percutaneous coronary intervention: Which one is better?

“…This is further supported by the recognition that bleeding events post‐PCI are associated with worse overall outcomes . Several studies have reported that the use of TAT results in similar rates of major adverse cardiovascular events (MACE) and major bleeding when compared to dual antithrombotic therapy (DAT) . However, many of these studies are observational and underpowered to detect such events.…”

“…2 Several studies have reported that the use of TAT results in similar rates of major adverse cardiovascular events (MACE) and major bleeding when compared to dual antithrombotic therapy (DAT). [3][4][5] However, many of these studies are observational and underpowered to detect such events. As a result, the optimal antithrombotic regimen post-PCI remains a subject of debate.…”

Antithrombotic therapy strategies for atrial fibrillation patients undergoing percutaneous coronary intervention: A systematic review and network meta-analysis

“…Conversely, non-VKA oral anticoagulant (NOAC) without these deficiencies has dramatically optimized anticoagulation management. Although antithrombotic efficacy and bleeding risk of NOACs for AF patients undergoing PCI in the real world has not been well established yet, several clinical studies have yielded different results of several antiplatelet and anticoagulant regimens for these patients[6–20]. This systematic review and network meta-analysis (NMA) aimed to rank efficacy and safety of different antithrombotic therapies available for AF patients in post-PCI.…”