Outcomes of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Sutton, Nadia R.; Seth, Milan; Ruwende, Cyril; Gurm, Hitinder S.

doi:10.1016/j.jacc.2016.05.085

Cited by 72 publications

(59 citation statements)

References 34 publications

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“…The two groups were comparable at the rates of all-cause death, nonfatal MI, and repeat unplanned revascularization ( P > 0.05 for all). As expected, patients with AF undergoing coronary stenting had significantly worse outcomes, as compared to patients without AF, which is in accordance with most recent studies,[7822] although in earlier study, AF was not independently predictive of mortality or major adverse cardiovascular events after 1 year except cerebrovascular events, bleeds, and vascular complications. [23] Our results differed from those previous studies[7814] in that no significant difference regarding the incidence of all-cause mortality at 12-month follow-up was found between AF and non-AF patients undergoing coronary stenting.…”

Section: Discussionsupporting

confidence: 90%

Current Use of Oral Anticoagulants and Prognostic Analysis in Patients with Atrial Fibrillation Undergoing Coronary Stenting

Zhai

Liu

Dong

et al. 2017

Chinese Medical Journal

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Background:It is currently believed that triple oral antithrombotic therapy in patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI) should be recommended if there are no contraindications. However, selecting triple therapy for AF patients undergoing PCI is still challenging when bleeding risk is considered. This study aimed to investigate the current use of oral anticoagulants (Vitamin K antagonists [VKA]) and perform prognostic analysis in real-world patients with AF undergoing coronary stenting.Methods:A total of 276 consecutive coronary artery disease (CAD) patients with or without AF undergoing coronary stenting were retrospectively evaluated and analyzed. The univariate and multivariate analyses were conducted to explore the current use of VKA and prognosis of patients with AF undergoing coronary stenting. The primary end-point was composite of all-cause death, nonfatal recurrent myocardial infarction, stroke, serious bleeding events, unplanned repeat revascularization, and worsening heart failure at 12-month follow-up after coronary stenting.Results:AF patients undergoing coronary stenting have more clinical concomitant diseases. Only 9.0% AF patients after coronary stenting received triple antithrombotic therapy (VKA, aspirin, and clopidogrel) at discharge. AF was independently associated with increased risk of the 12-month composite end-points (relative risk = 5.732, 95% confidence interval 1.786–18.396, P = 0.003).Conclusions:In real-life AF patients undergoing coronary stenting, guideline-recommended VKA was less used. AF patients had adjusted worse prognosis during 12-month follow-up after discharge. It is of utmost importance to improve the current status of oral anticoagulants use.

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Section: Discussionsupporting

confidence: 90%

Current Use of Oral Anticoagulants and Prognostic Analysis in Patients with Atrial Fibrillation Undergoing Coronary Stenting

Zhai

Liu

Dong

et al. 2017

Chinese Medical Journal

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“…Patients commonly have more than one thrombotic condition. Approximately 10–15% of individuals who require PCI have a history of AF . Consequently, these individuals may be prescribed a TT regimen.…”

Section: Patients With Multiple Indicationsmentioning

confidence: 99%

“…Consequently, these individuals may be prescribed a TT regimen. Major bleeding is already concerning in the setting of DAPT; however, when an anticoagulant is added, the risk for bleeding further increases . Clinicians are more experienced in using clopidogrel and warfarin as a part of TT, compared with other P2Y12 inhibitors or the DOACs.…”

Section: Patients With Multiple Indicationsmentioning

confidence: 99%

Contemporary Use of Oral Antithrombotic Agents: Focus on Dual and Triple Therapeutic Approaches

2017

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Atherosclerotic cardiovascular disease (ASCVD) represents a long-standing health care burden in most industrialized countries. Management of ASCVD is multifaceted, and utilization of antithrombotic agents is a key component of care to reduce vascular events. Minimizing thrombotic risk can be accomplished via antiplatelet or anticoagulant drugs; however, combination therapy is warranted for some indications. Although reducing thrombotic complications is important, it is equally vital to consider the safety of combination regimens. Thus clinicians must effectively balance both individualized thrombotic and bleeding risks when using this strategy. Scenarios occur in practice when determining the role for combination therapy is not clear, especially for patients with ASCVD who require both dual antiplatelet therapy plus anticoagulation. The aim of this review is to discuss the role of dual or triple antithrombotic therapies across the spectrum of thrombotic disease states. In addition to critiquing relevant research studies and evaluating key recommendations from nationally published guidelines and consensus statements involving the use of these agents, we offer practical considerations that can be utilized when managing patients with ASCVD.

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“…Atrial fibrillation (AF) has been reported in 3% to 12% of patients undergoing percutaneous coronary intervention (PCI) . The combination of vitamin K antagonists (VKA) with aspirin and clopidogrel—called “triple therapy”—was associated with an increased risk of major bleeding up to 2.2% within the first month and 12% at 1 year in acute coronary syndromes (ACS) patients …”

Section: Introductionmentioning

confidence: 99%

Vitamin K antagonist vs direct oral anticoagulants with antiplatelet therapy in dual or triple therapy after percutaneous coronary intervention or acute coronary syndrome in atrial fibrillation: Meta‐analysis of randomized controlled trials

Roule

Ardouin

Briet

et al. 2019

Clinical Cardiology

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Background The combination of vitamin K antagonists (VKA) for atrial fibrillation (AF) and antiplatelet agents following percutaneous coronary intervention (PCI) is associated with an increased bleeding risk. Hypothesis Direct oral anticoagulants (DOAC) are associated with a greater safety profile but the optimal antithrombotic treatment strategy, especially when considering ischemic events, is unclear. Methods We performed a meta‐analysis of randomized controlled trials comparing outcomes in AF patients following PCI and/or acute coronary syndrome (ACS) when treated with DOAC vs VKA, both in combination with one (dual) or two (triple) antiplatelet regimens. A systematic review was performed by searches of electronic databases MEDLINE (source PubMed) and the Cochrane Controlled Clinical Trials Register Database as well as Cardiology annual meetings. Three studies were finally included. Results Compared to VKA triple therapy, the use of DOAC was associated with a decreased risk of any bleeding (relative risk [RR] 0.68 [0.62; 0.74]), major bleeding (RR 0.61 [0.51; 0.75]) and intracranial bleeding (RR 0.33 [0.17; 0.66]) and similar rates of the composite efficacy endpoint (RR 1.0 [0.87; 1.14]) and its components. Similar and consistent results were observed with both dual and triple therapy including a DOAC compared to VKA. Conclusion Our meta‐analysis supports the use of dual therapy combining a DOAC and clopidogrel as the default regimen in most AF patients after PCI and/or ACS.

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Outcomes of Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Abstract: AF is common among patients undergoing PCI. AF is associated with older age, the presence of other comorbidities, and independently associated with in-hospital post-procedural heart failure, cardiogenic shock, and mortality.

Cited by 72 publications

References 34 publications

Current Use of Oral Anticoagulants and Prognostic Analysis in Patients with Atrial Fibrillation Undergoing Coronary Stenting

Current Use of Oral Anticoagulants and Prognostic Analysis in Patients with Atrial Fibrillation Undergoing Coronary Stenting

Contemporary Use of Oral Antithrombotic Agents: Focus on Dual and Triple Therapeutic Approaches

Vitamin K antagonist vs direct oral anticoagulants with antiplatelet therapy in dual or triple therapy after percutaneous coronary intervention or acute coronary syndrome in atrial fibrillation: Meta‐analysis of randomized controlled trials

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