Trends of Antithrombotic Treatment in Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention: Insights from the GReek-AntiPlatElet Atrial Fibrillation (GRAPE-AF) Registry

Benetou, Despoina-Rafailia; Varlamos, Charalampos; Ktenas, Dionysios; Tsiafoutis, Ioannis; Koutouzis, Michael; Bampali, Theodora; Mantis, Christos; Zarifis, John; Skalidis, Emmanouil; Aravantinos, D.; Varvarousis, Dimitrios; Lianos, Ioannis; Kanakakis, John; Pisimisis, E; Ziakas, Antonios; Davlouros, Periklis; Alexopoulos, Dimitrios; investigators, Grape-Af

doi:10.1007/s10557-020-07090-x

Cited by 5 publications

(7 citation statements)

References 39 publications

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“…During a transitional era of antithrombotic therapy strategies and evolving clinical practice guidelines, with type and duration of optimal treatment under question, GRAPE-AF study is a real-world registry providing contemporary data of AF patients undergoing PCI. 15 The main findings of present study are: (1) the risk of clinically significant bleeding and ischemic events was similar between patients receiving TAT or DAT at discharge. However, among TAT-receiving patients, long TAT (.1 month) patients were more likely to suffer from a significant bleeding event compared with short TAT (#1 month); (2) after IPTW-adjustment, risk for NACE was not different between TAT versus.…”

Section: Discussionmentioning

confidence: 50%

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One-Year Outcomes in Anticoagulated Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention: Insights From the Greek Antiplatelet Atrial Fibrillation Registry

Alexopoulos

Dragona

Varlamos

et al. 2023

Journal of Cardiovascular Pharmacology

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GReek-AntiPlatElet Atrial Fibrillation registry is a multicenter, observational, noninterventional study of atrial fibrillation patients undergoing percutaneous coronary intervention. Primary endpoint included clinically significant bleeding rate at 12 months between different antithrombotic regimens prescribed at discharge; secondary endpoints included major adverse cardiovascular events and net adverse clinical events. A total of 647 patients were analyzed. Most (92.9%) were discharged on novel oral anticoagulants with only 7.1% receiving the vitamin K antagonist. A little over half of patients (50.4%) received triple antithrombotic therapy (TAT)-mostly (62.9%) for #1 month-whereas the rest (49.6%) received dual antithrombotic therapy (DAT). Clinically significant bleeding risk was similar between TAT and DAT [Hazard ratio (HR) = 1.08; 95% confidence interval (CI), 0.66-1.78], although among TAT-receiving patients, the risk was lower in those receiving TAT for #1 month (HR = 0.50; 95% CI, 0.25-0.99). Anticoagulant choice (novel oral anticoagulant vs. vitamin K antagonist) did not significantly affect bleeding rates (P = 0.258). Age, heart failure, leukemia/myelodysplasia, and acute coronary syndrome were associated with increased bleeding rates. Risk of major adverse cardiovascular events and net adverse clinical events was similar between ΤAT and DAT (HR = 1.73; 95% CI, 0.95-3.18, P = 0.075 and HR = 1.39; 95% CI, 0.93-2.08, P = 0.106, respectively). In conclusion, clinically significant bleeding and ischemic rates were similar between DAT and TAT, although TAT .1 month was associated with higher bleeding risk.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

One-Year Outcomes in Anticoagulated Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention: Insights From the Greek Antiplatelet Atrial Fibrillation Registry

Alexopoulos

Dragona

Varlamos

et al. 2023

Journal of Cardiovascular Pharmacology

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“…In this context, large-scale observational clinical studies are strongly awaited to confirm in a 'realworld' setting what is recommended in the guidelines. Currently, all published prospective studies on this topic [13][14][15][16][17][18][19][20][21][22] enrolled a small number of patients that limits the possibility of reliable analyses on hard clinical end points.…”

Section: Discussionmentioning

confidence: 99%

“…In this context, large-scale observational clinical studies are strongly awaited to confirm in a ‘real-world’ setting what is recommended in the guidelines. Currently, all published prospective studies on this topic 13–22 enrolled a small number of patients that limits the possibility of reliable analyses on hard clinical end points. Only recently, a large prospective study 23 enrolling more than 1000 patients has been published showing a significant reduction in clinically relevant bleeding with DAT compared with TAT but a trend towards a higher risk of major adverse cardiovascular events (12.4 versus 9.6%, P = 0.17).…”

Section: Discussionmentioning

confidence: 99%

Design of the PERSEO Registry on the management of patients treated with oral anticoagulants and coronary stent

Sciahbasi

Gargiulo

Talarico

et al. 2022

Journal of Cardiovascular Medicine

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AimPercutaneous coronary intervention with stent implantation (PCI-S) in patients requiring chronic oral anticoagulant therapy (OAC) is associated with an increased risk of bleeding and ischemic complications. Different randomized studies showed a significant advantage of a double antithrombotic therapy and superiority of direct oral anticoagulant (DOAC) compared with warfarin, but real-world data are limited. Aim is to evaluate the antithrombotic management and clinical outcome of patients with an indication for OAC who undergo PCI-S in a ‘real-world’ setting.MethodsThe multicentre prospective observational PERSEO (PERcutaneouS coronary intErventions in patients treated with Oral anticoagulant therapy) Registry (ClinicalTrials.gov Identifier: NCT03392948) has been designed to enrol patients requiring OAC treated by PCI-S in 25 Italian centres. A target of at least 1080 patients will be followed for 1 year and data on thromboembolic and bleeding events and changes in antithrombotic therapy will be registered. The primary end point is a combined measure of efficacy and safety outcome (NACE), including major bleeding events and major adverse cardiac and cerebral events at 1-year follow-up in patients treated with DOAC (and dual or triple antiplatelet therapy) compared with the corresponding strategies with vitamin K antagonists. A secondary prespecified analysis has been defined to evaluate NACE in dual versus triple antithrombotic therapy after hospital discharge at 1-year follow-up.ConclusionThe PERSEO Registry will investigate in a ‘real world’ setting the safety and efficacy of DOAC versus warfarin and dual versus triple antithrombotic therapy in patients with indication for oral anticoagulant therapy who undergo PCI-S.

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“…Greek AntiPlatElet Atrial Fibrillation (GRAPE-AF) registry is a nationwide, prospective, single-arm, observational, non-interventional, cohort study, enrolling patients with non-valvular AF on OAC undergoing PCI with stent implantation in 18 PCI centers in Greece. The study, with rationale and design previously described in detail, aims to provide “real world” data regarding antithrombotic therapy [ 14 ]. Overall, 653 patients have been recruited (exclusion criteria in supplementary Table 1).…”

Section: Methodsmentioning

confidence: 99%

Platelet function testing in atrial fibrillation patients undergoing percutaneous coronary intervention

Lianos

Varlamos

Benetou

et al. 2022

J Thromb Thrombolysis

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Platelet function testing (PFT) could be a useful clinical tool to guide individualized antithrombotic treatment in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). We aimed to investigate platelet reactivity (PR) in the context of a contemporary registry. “Real-world” data were retrieved from a nationwide, multicenter, observational study of AF patients on oral anticoagulants (OAC) undergoing PCI. Patients treated with a P2Y12 inhibitor, namely clopidogrel or ticagrelor, as part of double or triple antithrombotic therapy, were submitted to PFT before discharge and were followed up for 12 months. Out of 101 patients included in the study, 66 were submitted to PFT while on clopidogrel and 35 while on ticagrelor; PR was 162.9 ± 68 PRU and 46.02 ± 46 PRU, respectively (P < 0.001). High on-treatment PR (HTPR) was observed in 15 patients under clopidogrel (22.7%); 7 of them escalated to ticagrelor. Low on-treatment PR (LTPR) was found in 9 clopidogrel and 28 ticagrelor-treated patients (13.6% vs. 80%, P < 0.001), of whom only 1 de-escalated to clopidogrel. PR did not differ by OAC regimen. PFT results had no impact on aspirin prescription at discharge, while failed to predict significant bleeding events at follow up. Ticagrelor administration led to lower PR and lower incidence of HTPR in comparison with clopidogrel. Physicians’ behavior in response to knowledge of a patient’s PR was variable. Further studies are required to elucidate the role of PFT as a tool to guide individualized antithrombotic treatment in this clinical scenario.

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Trends of Antithrombotic Treatment in Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention: Insights from the GReek-AntiPlatElet Atrial Fibrillation (GRAPE-AF) Registry

Cited by 5 publications

References 39 publications

One-Year Outcomes in Anticoagulated Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention: Insights From the Greek Antiplatelet Atrial Fibrillation Registry

One-Year Outcomes in Anticoagulated Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention: Insights From the Greek Antiplatelet Atrial Fibrillation Registry

Design of the PERSEO Registry on the management of patients treated with oral anticoagulants and coronary stent

Platelet function testing in atrial fibrillation patients undergoing percutaneous coronary intervention

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