A retrospective cohort study of oral anticoagulant treatment in patients with acute coronary syndrome and atrial fibrillation

Mai, Linlin; Wu, Yu; Luo, Jianjing; Liu, Xinyue; Zhu, Hailan; Zheng, Haoxuan; Guo-quan, Liang; Zhang, Yan; Huang, Yuli

doi:10.1136/bmjopen-2019-031180

Cited by 9 publications

(9 citation statements)

References 36 publications

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“…A high prevalence of concomitant cardiac and extra-cardiac diseases was shown, in particular arterial hypertension, diabetes mellitus, heart failure, and coronary artery disease. This profile of comorbidities at baseline was in agreement with previous analyses[ 46 , 53 , 63 , 67 , 68 ]. In the Akershus Cardiac Examination 1950 study, 87.6% of men with AF and 86.4% of women with AF had comorbidities, compared with 74.4% and 66.3%, respectively, without AF[ 3 ].…”

Section: Discussionsupporting

confidence: 92%

Time trends in antithrombotic therapy prescription patterns: Real-world monocentric study in hospitalized patients with atrial fibrillation

Abrignani¹,

Lombardo²,

Braschi³

et al. 2022

World J Cardiol

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BACKGROUND Since 2010, the European Society of Cardiology has extended prescription criteria for oral antithrombotic therapy (OAT) in atrial fibrillation (AF). Direct oral anticoagulants (DOACs) were upgraded from an IIAa recommendation in 2012 to an IA in 2016. In real-world scenarios, however, OAC prescription is still suboptimal, mainly for DOACs. AIM To evaluate OAT temporal prescription patterns in a cohort of patients hospitalized with AF in a Cardiology Department. METHODS A retrospective observational study was conducted on a cohort of hospitalized patients in a secondary setting (Trapani, Italy) from 2010 to 2021 with AF as the main or secondary diagnosis. For 4089 consecutive patients, the variables extracted from the Cardiology department database were: Sex, age, time of hospitalization, antithrombotic therapy (warfarin, acenocoumarol, apixaban, dabigatran, edoxaban, rivaroxaban, aspirin, clopidogrel, other antiplatelet agents, low molecular weight heparin, and fondaparinux), diagnosis at discharge and used resources. Basal features are presented as percentage values for categorized variables and as mean +/- SD for categorized once. RESULTS From January 1st, 2010 to October 6th, 2021, 25132 patients were hospitalized in our department; 4089 (16.27%, mean age 75.59+/-10.82) were discharged with AF diagnosis; of them, 2245 were males (54.81%, mean age 73.56+/-11.45) and 1851 females (45.19%, mean age 78.06+/-9.47). Average length of stay was 5.76+/-4.88 days; 154 patients died and 88 were moved to other Departments/Structures. AF was the main diagnosis in 899 patients (21.94%). The most frequent main diagnosis in patients with AF was acute myocardial infarction (1973 discharges, 48.19%). The most frequent secondary cardiac diagnosis was chronic coronary syndrome (1864 discharges, 45.51%), and the most frequent secondary associated condition was arterial hypertension (1010 discharges, 24.66%). For the analysis of antithrombotic treatments, the final sample included 3067 patients, after excluding in-hospital deaths, transferred out or self-discharged patients, as well as discharges lacking indications for prescribed treatments. OAC treatment increased significantly (35.63% in 2010-2012 vs 61.18% in 2019-2021, +25.55%, P < 0.0001), in spite of any antiplatelet agent use. This rise was due to increasing use of DOACs, with or without antiplatelet agents, from 3.04% in 2013-2015 to 50.06% in 2019-2021 (+47.02%, P < 0.0001) and was greater for factor Xa inhibitors, especially apixaban. In addition, treatment with a vitamin K antagonist, in spite of any antiplatelet agent use, decreased from 35.63% in 2010-2012 to 11.12% in 2019-2021 (-24.48%, P < 0.0001), as well as any antiplatelet therapy, alone or in double combination, (49.18% in 2010-2012 vs 34.18% in 2019-2021, -15.00%,...

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Section: Discussionsupporting

confidence: 92%

Time trends in antithrombotic therapy prescription patterns: Real-world monocentric study in hospitalized patients with atrial fibrillation

Abrignani¹,

Lombardo²,

Braschi³

et al. 2022

World J Cardiol

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“…Thus, future studies are warranted to create a dedicated risk score specifically designed to predict bleeding events in a large Chinese observational database of patients undergoing PCI, which might improve risk assessment and support clinicians' decisions with respect to DAPT. Seventh, although current guidelines recommended triple antithrombotic therapy (oral anticoagulant, aspirin, and P2Y12 inhibitor) for patients with AF undergoing PCI during hospitalization 51) , oral anticoagulant therapy was greatly underused for these patients in the present study, which was consistent with previous reports [52][53][54] . Part of the underlying reasons for the low use of anticoagulation therapy may be explained by: 1) concerns of bleeding complications, 2) lack of awareness of anticoagulation therapy for physicians 55) , 3) limited evidence of clinical research data and consensus guidelines for management of antithrombotic therapy in AF patients undergoing PCI, and 4) unavailability of non-vitamin K antagonist oral anticoagulants during the time of enrollment in China in real-world clinical practice.…”

Section: Fig 5 Cumulative Incidence Of Endpoint Events According To Esc/eacts-hir Criteria and Bleeding Risk Categorizationsupporting

confidence: 88%

Prognostic and Practical Validation of ESC/EACTS High Ischemic Risk Definition on Long-Term Thrombotic and Bleeding Events in Contemporary PCI Patients

Wang

Yin

Zhao

et al. 2022

JAT

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The ESC/EACTS myocardial revascularization guidelines recently standardized the definition of patients at high ischemic risk (HIR). However, the ability of ESC/EACTS-HIR criteria to stratify ischemic and bleeding risk in a contemporary real-world East Asian cohort remains unexplored. Methods: A total of 10,167 consecutive patients undergoing PCI from prospective Fuwai PCI Registry (January 2013 to December 2013) were reviewed. ESC/EACTS-HIR features was defined as having at least one of the eight clinical and angiographic characteristics. The primary ischemic endpoint was target vessel failure (cardiac death, target vessel myocardial infarction [MI], or target vessel revascularization [TVR]); bleeding outcome was assessed using the BARC type 2, 3, or 5 bleeding. Median follow-up was 29 months. Results: Compared with non-HIR patients, HIR patients (n 5,149, 50.6%) were associated with increased risk for target vessel failure (adjusted hazard ratio [HRadjust]: 1.48 [1.25-1.74]) and patient-oriented composite outcome (HRadjust: 1.44 [1.28-1.63]), as well as cardiac death, MI, and TVR. By contrast, the risk of clinically relevant bleeding was not significantly different between the two groups. (HRadjust: 0.84 [0.66-1.06]). Greater than or equal to three implanted stents and diabetic patients with diffuse multivessel coronary disease emerged as independent predictors for long-term adverse outcomes. There was no significant interaction between high bleeding risk (HBR) status and clinical outcomes associated with ESC/EACTS-HIR criteria (all Pinteraction 0.05). Conclusion:The ESC/EACTS-HIR features identified patients at increased risk of thrombotic events, including cardiac death, but not for clinically relevant bleeding. Importantly, HBR did not modify cardiovascular risk subsequent to patients with ESC/EACTS-HIR features, suggesting its potential clinical applicability in tailoring antithrombotic therapy. and the advent of newer drugs and devices have allowed expanding the use of percutaneous coronary intervention (PCI) to several complex clinical IntroductionAdvances in interventional cardiology techniques

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“…Mai et al reported a retrospective data in Southern China that showed the prescription rate of OACs at discharge for patients with AF and ACS from 2013 to 2018 was only 21.7%. [ 37 ] The inadequate implementation of guidelines recommendation were more common in Asia as individuals of Asian ethnicity were considered more vulnerable to anticoagulant-related bleeding, especially using VKA. [ 38 ] Among 12,165 Danish population of AF patients hospitalized with MI or PCI between 2001 and 2009, only 3,590 (29.5%) patients received DAPT.…”

Section: Discussionmentioning

confidence: 99%

Changes of antithrombotic prescription in atrial fibrillation patients with acute coronary syndrome or percutaneous coronary intervention and the subsequent impact on long-term outcomes: a longitudinal cohort study

et al. 2021

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Objectives The choice of optimal antithrombotic therapy in atrial fibrillation (AF) patients with acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) remains controversial. The aim of this longitudinal cohort study is to investigate the prescribing pattern of antithrombotic regimen in different cohorts and its subsequent impact. Setting and design Longitudinal data from the Tri-Service General Hospital-Coronary Heart Disease (TSGH-CHD) registry, between January 2016 and August 2018 was screened. Participants and method Patients with prior history of nonvalvular AF, who had ACS presentation or underwent PCI were selected, and these patients were divided into cohort 1 and cohort 2, according to the index date of antithrombotic prescription before and after the PIONEER AF-PCI study. Primary and secondary outcomes The primary safety endpoints were composites of major bleeding and/or clinically relevant non-major bleeding. The secondary efficacy endpoints included the occurrence of all-cause mortality, stroke/systemic embolization, nonfatal myocardial infarction (MI), and >30-days coronary revascularization. Results A total of 121 patients were included into analysis (cohort 1=35; cohort 2=86). Comparing with cohort 1, the prescription rate of triple antithrombotic therapy (TAT) increased from 17.1 to 38.4%, especially the regimen with dual antiplatelet therapy (DAPT) plus low-dose non-vitamin-K dependent oral anticoagulation (NOAC). However, the prescription rate of dual antithrombotic therapy (DAT) decreased (14.3–10.5%), as well as the prescription rate of DAPT (68.6–51.2%). These changes of antithrombotic prescription across different cohorts were not associated with risk of adverse safety (HR= 0.87; 95% CI, 0.42-1.80, p=0.710) and efficacy outcomes (HR=0.96; 95% CI, 0.40-2.32, p=0.930). Conclusions Entering the NOAC era, the prescription of TAT increased alongside the decrease in DAT. As the prescription rate of DAPT without anticoagulation remained high, future efforts are mandatory to improve the implementation of guidelines and clinical practice.

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A retrospective cohort study of oral anticoagulant treatment in patients with acute coronary syndrome and atrial fibrillation

Cited by 9 publications

References 36 publications

Time trends in antithrombotic therapy prescription patterns: Real-world monocentric study in hospitalized patients with atrial fibrillation

Time trends in antithrombotic therapy prescription patterns: Real-world monocentric study in hospitalized patients with atrial fibrillation

Prognostic and Practical Validation of ESC/EACTS High Ischemic Risk Definition on Long-Term Thrombotic and Bleeding Events in Contemporary PCI Patients

Changes of antithrombotic prescription in atrial fibrillation patients with acute coronary syndrome or percutaneous coronary intervention and the subsequent impact on long-term outcomes: a longitudinal cohort study

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