Outcomes in relation to antithrombotic therapy among patients with atrial fibrillation after percutaneous coronary intervention

Park, Jiesuck; Choi, Eue Keun; Han, Kyung Do; Kim, Tae Hyuk; Choi, Yong‐Keel; Lee, So‐Ryoung; Kang, Jeehoon; Jin, Myung; Park, Kyung Woo; Oh, Seil; Lip, Gregory Y.H.

doi:10.1371/journal.pone.0240161

Cited by 2 publications

(3 citation statements)

References 28 publications

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“…This suggests a preference for 1-year post-PCI maintenance DAPT even after the widespread availability of NOACs, which resulted in overtreatment and noncompliance with the guideline recommendations [ 1 , 2 ]. Compared with double therapy, such overtreatment with prolonged triple therapy increases bleeding risk without additional benefit in reducing thromboembolic risk [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Patterns in Antithrombotic Therapy in Patients with Atrial Fibrillation after Percutaneous Coronary Intervention in the Non-Vitamin K Oral Anticoagulant Era: A Nationwide Population-Based Study

Park

Jung

Choi

et al. 2021

JCM

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We investigated whether longitudinal patterns in antithrombotic therapy have changed after the introduction of non-vitamin K oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI). Using a claims database of the Korean AF population who underwent PCI between 2012 and 2016 (n = 18,691), we analyzed prescription records of oral anticoagulants (OACs) and antiplatelets at 3-month intervals over 2 years after PCI. The study population was stratified (pre-NOAC, transition, and NOAC era) using time-periods of NOAC introduction in Korea and an expansion of reimbursement for NOAC in AF as indicators. The overall rates of OAC were low at baseline (24.9%, 26.9%, and 35.2% in pre-NOAC, transition, and NOAC era, respectively), contrary to high rates of dual antiplatelet therapy (DAPT) (73.3%, 71.4%, and 63.6%). However, OAC prescription rates were increased at 1-year (18.5%, 22.5%, and 31.6%), and 2-year follow-up (17.8%, 24.2%, and 31.8%) from pre-NOAC to NOAC era. In NOAC era, 63.5% of baseline OAC prescriptions comprised NOAC, of which 96.4% included triple therapy with DAPT. Over 2 years, we observed increasing rates of double therapy with a single antiplatelet (18.3% and 20.0% at 1- and 2-year follow-up) and OAC monotherapy (2.7% and 8.9% at 1- and 2-year follow-up).

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Section: Discussionmentioning

confidence: 99%

Longitudinal Patterns in Antithrombotic Therapy in Patients with Atrial Fibrillation after Percutaneous Coronary Intervention in the Non-Vitamin K Oral Anticoagulant Era: A Nationwide Population-Based Study

Park

Jung

Choi

et al. 2021

JCM

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“…Furthermore, CAD is associated with a higher incidence of thromboembolic (TE) events, even in patients without AF 5,6 . The management of AF patients with previous MI or revascularization has attracted much attention because of the complexity of antithrombotic treatment in this setting 7–11 …”

Section: Introductionmentioning

confidence: 99%

“…5,6 The management of AF patients with previous MI or revascularization has attracted much attention because of the complexity of antithrombotic treatment in this setting. [7][8][9][10][11] As data among Asian patients are still sparse, we aimed to evaluate the coexistence and impact of CAD on clinical outcomes among elderly Chinese AF patients enrolled in the nationwide, prospective registry.…”

Section: Introductionmentioning

confidence: 99%

Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

Kotalczyk

Guo

Fawzy

et al. 2022

Journal of Arrhythmia

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Background Atrial fibrillation (AF) and coronary artery disease (CAD) are closely related; CAD may precede or complicate the clinical course of AF. Objective To evaluate the impact of CAD on clinical outcomes among elderly Chinese AF patients. Methods The ChiOTEAF registry is a prospective registry conducted in 44 sites from 20 provinces in China between October 2014 and December 2018. Primary outcome was the composite of all‐cause mortality/any thromboembolism (TE)/major bleeding/acute coronary syndrome (ACS). Results The eligible cohort for this analysis included 6403 individuals (mean age 74.8 ± 10.7; 39.2% female); of these, 3058 (47.8%) had a history of CAD. On multivariate analysis, CAD was independently associated with a higher odds ratio for ACS (OR: 1.98; 95% CI: 1.12–3.52) without a significant impact on other adverse outcomes. Independent variables associated with the composite outcome among CAD patients were: (i) the use of OAC (OR: 0.55; 95% CI: 0.42–0.72), age (OR: 1.09; 95% CI: 1.08–1.11), heart failure (OR: 1.95; 95% CI: 1.51–2.50), prior ischemic stroke (OR: 1.29; 95% CI: 1.02–1.64), chronic kidney disease (OR: 1.71; 95% CI: 1.32–2.22), and chronic obstructive pulmonary disease (OR: 1.42; 95% CI: 1.06–1.89). Conclusions AF patients with CAD were at an increased risk of developing ACS but there was no significant difference in the composite outcome, all cause death, cardiovascular death, thromboembolic events or major bleeding compared to the non‐CAD group. OAC use was inversely associated with adverse events, yet their uptake was poor in the AF‐CAD population.

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Outcomes in relation to antithrombotic therapy among patients with atrial fibrillation after percutaneous coronary intervention

Cited by 2 publications

References 28 publications

Longitudinal Patterns in Antithrombotic Therapy in Patients with Atrial Fibrillation after Percutaneous Coronary Intervention in the Non-Vitamin K Oral Anticoagulant Era: A Nationwide Population-Based Study

Longitudinal Patterns in Antithrombotic Therapy in Patients with Atrial Fibrillation after Percutaneous Coronary Intervention in the Non-Vitamin K Oral Anticoagulant Era: A Nationwide Population-Based Study

Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

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