Antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, including compliance with current guidelines—data from the POLish Atrial Fibrillation (POL-AF) Registry

Abstract

Background: Although triple antithrombotic therapy (TAT) is recommended in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), guidelines allow an option of dual antithrombotic therapy (DAT). This study assesses the everyday practice of 10 cardiology departments in antithrombotic therapy in AF patients undergoing PCI and its agreement with current guidelines.Methods: This analysis included medical data of AF patients enrolled in the prospective, observational registry (The POLish Atrial Fibrillation-POL-AF) that underwent PCI [elective or due to acute coronary syndrome (ACS)].Results: Of the 3,999 consecutive subjects included, a final analysis was performed on 359 patients that underwent PCI: 148 with urgent PCI due to ACSand 211 patients with elective PCI. Eighty patients in the ACS-group and 120 patients in the elective-PCI group were treated with TAT, although guidelines also allowed DAT. Of 316 patients treated with oral anticoagulants as a part of combination therapy, 275 were on non-vitamin K antagonist oral anticoagulant (NOAC). Reduced doses of NOAC were used in 74 patients treated with rivaroxaban, 60 patients with dabigatran, and 54 patients with apixaban. The proportion of patients treated with reduced NOAC doses adequately to the guidelines was 29%, 100%, and 33% for rivaroxaban, dabigatran, and apixaban, respectively. Inappropriate low doses of NOACs were used in 71% of subjects on rivaroxaban and 67% on apixaban. Conclusions:In patients with AF undergoing PCI, NOACs are definitely preferred over vitamin-K antagonists (VKAs) in TAT/DAT, and an aggressive antithrombotic strategy with TAT is frequently chosen even if DAT is permissible by the guidelines. Label adherence of using reduced NOAC dose during

Guideline Adherence As An Indicator of the Extent of Antithrombotic Overuse and Underuse: A Systematic Review

“…Study designs included 14 retrospective record reviews [ 20 21 22 23 24 25 26 27 28 29 30 31 32 33 ], 6 cohort studies [ 34 35 36 37 38 39 ] and 1 a case-control [ 40 ] (see Table 1 ). Four studies focused on overuse, 5on underuse, and 12 on both.…”

Symptomatic and Asymptomatic Patients in the Polish Atrial Fibrillation (POL-AF) Registry

“…The analysis was carried out on a group of patients from the Polish Atrial Fibrillation (POL-AF) registry. The methodology has been previously described in detail [9,10]. The POL-AF registry is a prospective, observational, multicenter study.…”

Czy wynik CHA2DS2-VASc determinuje leczenie przeciwzakrzepowe u pacjentów z migotaniem przedsionków? Dane z POLish Atrial Fibrillation (POL-AF) Registry?

“…Interestingly, in the presented study, AF type or impaired kidney function were not shown to be the predictors of OAC use in patients at low thromboembolic risk. It has been reported that the aforementioned factors increase the risk of thromboembolic complications in patients with AF or predispose them to thrombus formation in the left atrial appendage [8][9][10][11][12][13][14][15][16][17][18][19][20]. Study results connected with anticoagulant overtreatment of patients with AF prove that it is common and most likely stems from using OACs due to temporary indications to anticoagulant therapy and from the presence of thromboembolic risk factors not included in the CHA 2 DS 2 -VASc score.…”

“…The POL-AF Registry (NCT04419012) was a prospective, observational study enrolling AF patients hospitalized in 10 cardiology departments in Poland (eight of them were academic and two regional). Details on the study design have been reported elsewhere [9][10][11]. In brief, consecutive hospitalized patients were included in the study on the condition that they were at least 18 years of age and had AF history reported by electrocardiography or in their case record.…”