Efficacy and safety of aspirin, clopidogrel, and warfarin after coronary artery stenting in Korean patients with atrial fibrillation

Abstract

There are limited data on the optimal antithrombotic therapy for patients with atrial fibrillation (AF) who undergoing coronary stenting. We reviewed 203 patients (62.6 % men, mean age 68.3 ± 10.1 years) between 2003 and 2012, and recorded clinical and demographic characteristics of the patients. Clinical follow-up included major adverse cardiac and cerebrovascular events (MACCE) (cardiac death, myocardial infarction, target lesion revascularization, and stroke), stent thrombosis, and bleeding. The most commonly associated comorbidities were hypertension (70.4 %), diabetes mellitus (35.5 %), and congestive heart failure (26.6 %). Sixty-three percent of patients had stroke risk higher than CHADS2 score 2. At discharge, dual-antiplatelet therapy (aspirin, clopidogrel) was used in 166 patients (81.8 %; Group I), whereas 37 patients (18.2 %) were discharged with triple therapy (aspirin, clopidogrel, warfarin; Group II). The mean follow-up period was 42.0 ± 29.0 months. The mean international normalized ratio (INR) in group II was 1.83 ± 0.41. The total MACCE was 16.3 %, with stroke in 3.4 %. Compared with the group II, the incidence of MACCE (2.7 % vs 19.3 %, P = 0.012) and cardiac death (0 % vs 11.4 %, P = 0.028) were higher in the group I. Major and any bleeding, however, did not differ between the two groups. In multivariate analysis, no warfarin therapy (odds ratio 7.8, 95 % confidence interval 1.02-59.35; P = 0.048) was an independent predictor of MACCE. By Kaplan-Meier survival analysis, warfarin therapy was associated with a lower risk of MACCE (P = 0.024). In patients with AF undergoing coronary artery stenting, MACCE were reduced by warfarin therapy without increased bleeding, which might be related to tighter control with a lower INR value.

Triple Therapy Versus Dual Antiplatelet Therapy for Patients with Atrial Fibrillation and Acute Coronary Syndromes: A Systematic Literature Review

“…The proportion of patients with an ACS ranged from 40% in Suh et al . (2014) [ 16 ] to 100% in Fosbol et al . (2013) [ 13 ].…”

“…reported mortality of 13.3% on DAPT versus 12.9% on TT without adjusted results being given [ 13 ], Suh et al . reported 11.4% mortality on DAPT, with no deaths in the 37 patients treated with TT [ 16 ], and Rubboli et al . reported 11% mortality rates in both groups [ 15 ].…”

“…Bleeding risk, using either HAS-BLED [ 24 ] or ATRIA [ 25 ] scores were reported in 7 of the 10 studies. In 5 of these studies there was no statistical difference in bleeding risk between treatment arms [ 13 , 15 , 16 , 18 , 19 ]. Lamberts et al .…”

“…[ 15 ], Suh et al . [ 16 ] and Ho et al . [ 17 ]) did not find significant differences between bleeding rates while three studies (Fosbol et al .…”

Prescription patterns of oral anticoagulants for patients with non-valvular atrial fibrillation: experience at a Japanese single institution

“…However, a role of NOACs in secondary prevention of MI has not been fully elucidated. The majority of patients with previous MI received antiplatelet therapy [26,27]. Adding antiplatelet therapy to warfarin in patients with AF and coronary artery disease is not associated with a reduction in the risk of recurrent coronary events or thromboembolism, whereas the risk of bleeding is increased significantly [25,28].…”