Antithrombotic therapy and its impact on prognosis in patients with atrial fibrillation and myocardial infarction. Long-term observation results

Abstract

Aim. To study antithrombotic therapy (ATT) in patients with myocardial infarction (MI) type 1 and preexisting atrial fibrillation (AF), effect of ATT on prognosis.
 Material and methods. 100 patients with type 1 MI and preexisting AF were selected. The exclusion criterion was severe concomitant pathology.
 Results. Only 13.0% of AF patients took anticoagulants (AC) adequately before hospitalization. 94.0% of patients in hospital and 80.5% at discharge were prescribed triple ATT at least for 1 month with transition to dual ATT (AC + disaggregant) for 12 months. ACs were prescribed in hospital in 100.0% of cases, at discharge in 93.1%. After 1 year 8.4% of patients stopped taking ACs, after 2.31.9 years 15.7%. The incidence of ischemic and hemorrhagic events didnt differ in patients with different regimens of ATT (double/triple) and types of AСs (vitamin K antagonists/non-vitamin K antagonist ACs). In the long-term period patients, who took ACs incorrectly or stopped taking ACs, had increased risks of stroke (OR 9.580; 95% CI 1.15379.599, p=0.0365); combined endpoint: recurrent MI + stroke + cardiovascular mortality (OR 2.556; 95% CI 1.1045.918, p=0.0284).
 Сonclusion. Patients with preexisting AF had a low adherence to ACs prior to MI. It increased after hospitalization and decreased during follow-up. In the long-term period patients, who took ACs incorrectly or stopped taking ACs, had significantly increased risks of stroke, combined endpoint. There were no differences in the prognosis depending on the type of ACs, the regimens of ATT administered in accordance with ischemic and hemorrhagic risks.

Changes in Antithrombotic Therapy Prescription in Patients with a Combination of Atrial Fibrillation and Myocardial Infarction in a Specialised Inpatient Department from 2016–2019 and Associations with Prognosis

“…In the research, the incidence of AF in MI was 12.5% and was in the frequency range of 2–23% received by other authors, both in other countries [ 17 , 18 , 19 ] and in other regions of Russia [ 20 , 21 ].…”

“…At the beginning of this research, the prescription rate of ATT was 6.7%, and it was higher than the prescription rate of ATT received in the 2013–2014 CAMI research in China, where it was 1.7% [ 22 ] and much lower than indicated in the research of Z. G. Tatarintseva et al [ 23 ], conducted in Krasnodar Krai, where the frequency of TATT prescription in the period of 2015–2017 was 62.8%, and the work of M.V. Solovieva and S.A. Boldueva [ 21 ], conducted in the period of 2013–2018 in St. Petersburg, where this index was 80.5%.…”

“…At the same time, the percentage of patients who did not receive ATT remained the same in both studies [ 21 ].…”

Inhospital outcomes of myocardial infarction in patients receiving direct oral anticoagulants

“…Оптимистичные данные современных клинических исследований, позволяют рассматривать возможность включения препаратов группы пероральных антикоагулянтов (ПОАК) в схему антитромботической терапии у пациентов с ИБС, представляющих категорию высокого риска атеротромботических осложнений [8,9].…”