Evolving Antithrombotic Treatment Patterns for Patients With Nonvalvular Atrial Fibrillation and Acute Coronary Syndrome or Underwent Percutaneous Coronary Intervention in China: A Cross-Sectional Study

Abstract

ObjectiveAntithrombotic therapy in patients with nonvalvular atrial fibrillation (NVAF) concomitant with the acute coronary syndrome (ACS) or underwent percutaneous coronary intervention (PCI) is challenging and has evolved in recent years. However, real-world data on this issue about antithrombotic regimens at discharge and its evolving trend were relatively scarce, especially in China.MethodsA total of 2,182 patients with NVAF and ACS/PCI were enrolled from 2017 to 2019. A total of 1,979 patients were finally analyzed and divided in three sequential cohorts: cohort 1 (2017), n = 674; cohort 2 (2018), n = 793; and cohort 3 (2019), n = 512. Baseline characteristics and antithrombotic therapy at discharge were analyzed by cohort.ResultsIn our cross-sectional study, the majority of patients (59.6%) received dual antiplatelet therapy (DAPT). Over the 3 years, DAPT prescription reduced from nearly 70% to <50% (P trend < 0.001), while triple therapy (TT)/double therapy (DT) increased from 27.2 to 50.0% (P trend < 0.001). This trend was also seen in different subgroups stratified by CHA2DS2-VASc score, HAS-BLED score, coronary artery disease type, or management type, and was validated after multivariate adjustment. Persistent atrial fibrillation and history of congestive heart failure, hypertension, diabetes mellitus, and stroke/transient ischemic attack/systemic embolism were the independent predictors of TT/DT use, while ACS, PCI, or advanced chronic kidney disease was related with more DAPT prescription.ConclusionThere is a shift of antithrombotic regime at discharge for patients with NVAF with recent ACS/PCI with reducing DAPT prescription and increasing TT/DT prescription. While the appropriate antithrombotic regimen for patients with NVAF having ACS/PCI is still underused in China.

An analysis of antithrombotic therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary interventions

“…However, those data are mostly based on Western populations, and Chinese studies have also shown that patients with high CHA 2 DS 2 -VASc scores have a high stroke risk. 31,49 There was a significant difference between the CHA 2 DS 2 -VASc score in our study and that reported in other studies, 12 with an average score of 4.6 points, most likely reflecting the age of patients who were older than 65 years and exhibited more comorbid conditions, including hypertension, diabetes and prior strokes/TIAs. In this study, we found that the CHA 2 DS 2 -VASc score was significantly related to the occurrence of MACCEs in elderly patients, and those patients who received ATT were less prone to MACCEs.…”

“…Ischemic strokes among AF patients without anticoagulation, measured by the CHA 2 DS 2 ‐VASc score, were reported at 0.44% to 4.0% over all, 39,40 patients at low risks 37,38,41,42 were treated with 0% to 0.95%, those with intermediate risks 43–45 were treated with 0.10% to 6.6%, and those at high‐risk 46–48 were treated with 2.4% to 6.2% from prior studies. However, those data are mostly based on Western populations, and Chinese studies have also shown that patients with high CHA 2 DS 2 ‐VASc scores have a high stroke risk 31,49 . There was a significant difference between the CHA 2 DS 2 ‐VASc score in our study and that reported in other studies, 12 with an average score of 4.6 points, most likely reflecting the age of patients who were older than 65 years and exhibited more comorbid conditions, including hypertension, diabetes and prior strokes/TIAs.…”

“…According to a Korean study 21 examining their nationwide registries from 2013 to 2018, patients with AF after PCI rarely received OAC, indicating that the proportion of OAC patients with AF after PCI is low, and the proportion of patients with DAPT is 49.8% to 71.9%. According to a cross‐sectional study conducted in China, 31 2182 patients with NVAF and ACS/PCI between 2017 and 2019 received antithrombotic treatment. DAPT was prescribed to 50% to 70% of patients at discharge in a total of 1979 patients.…”

Efficacy and safety evaluation of rivaroxaban vs. warfarin among non-valvular atrial fibrillation patients undergoing lower extremity revascularization

“…However, in patients with AF undergoing lower-extremity revascularisation, antithrombotic strategies remain a challenge in clinical practice. The risk of ischaemic and haemorrhagic events must be carefully balanced ( 15 ). In patients with AF and PAD, there is a significant 56% reduction in the incidence of acute limb events when receiving rivaroxaban compared with that when receiving warfarin ( 1 ), and current clinical practice is more inclined to the use of NOACs, such as rivaroxaban.…”

“…To date, several studies have focused on the issue of reduced rivaroxaban doses in Asian populations. Asians are more prone to anticoagulant-related and intracranial bleeding than Caucasians owing to differences in race and lifestyle ( 15 ). Another study showed that in healthy Chinese individuals, 10 mg rivaroxaban may be sufficient to reach 83% of inhibition of factor Xa activity caused by a 20-mg dose ( 17 ).…”