Temporal trends in prevalence and antithrombotic treatment among Asians with atrial fibrillation undergoing percutaneous coronary intervention: A nationwide Korean population-based study

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

doi:10.1371/journal.pone.0209593

Cited by 23 publications

(31 citation statements)

References 34 publications

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“…A recent report examining the prescription pattern of antithrombotic therapy in patients with AF undergoing PCI revealed that the number of patients with AF and PCI has increased constantly, but OAC prescription was only 40% in 2015. 32) Furthermore, more than 70% of patients received antiplatelet agents only one-year after PCI. 33) Considering that most of these patients have a high risk of stroke, optimal antithrombotic therapy may be necessary after PCI.…”

Section: Cardiovascular Researchers Using the National Health Informamentioning

confidence: 99%

Cardiovascular Research Using the Korean National Health Information Database

2020

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The Korean National Health Information Database (NHID) contains nationwide claims data, including sociodemographic data, health care utilization, health screening data, and healthcare provider information. To compensate for the limitations of randomized clinical trials, real-world observational studies using claims data have emerged as a novel research tool. We summarized the structure of the Korean NHID and the recent researches conducted in the field of cardiovascular science. Epidemiological studies, prescription patterns, temporal trends, comparison of effectiveness and safety of treatments, variability index using laboratory data, and rare intractable disease constitute interesting topics of research in cardiovascular science using the NHID. The operational definition of covariates and clinical outcomes is important for researchers interested in using the NHID data as new tools to prove their hypothesis. A step-by-step approach adopted by a team of data scientists, epidemiologists, statisticians, and clinical researchers may be most effective while designing research studies. The ultimate direction of research using the NHID should aim to improve the welfare of the public by promoting public health, reducing medical costs, and guiding healthcare policies.

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Section: Cardiovascular Researchers Using the National Health Informamentioning

confidence: 99%

Cardiovascular Research Using the Korean National Health Information Database

2020

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“…One study investigated the temporal trends of antithrombotic therapy in Korean AF-PCI patients during 2006 and 2015, whereby the proportion of TAT increased from 22.7% to 38.2%, but DAPT still comprised the largest proportion at 60.3%. 12) However, there is a caveat that this 10/14 https://e-kcj.org https://doi.org/10.4070/kcj.2020.0407…”

Section: Discussionmentioning

confidence: 99%

Impact of Non-Vitamin K Antagonist Oral Anticoagulants on the Change of Antithrombotic Regimens in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

et al. 2021

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Background and Objectives: Antithrombotic therapy after percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF) has changed in recent years with new data from large randomized trials and updates to clinical guidelines. This study aimed to investigate the trends in periprocedural antithrombotic regimens in Korean patients with AF undergoing PCI with non-vitamin K antagonist oral anticoagulants (NOACs). Methods: Using the claims database of the Health Insurance Review and Assessment during 2013-2018, 27,594 patients with AF undergoing PCI were identified. The annual prevalence of PCI and prescriptions of each antithrombotic agent, including antiplatelet agents and oral anticoagulants, within 30 days after PCI were investigated. Results: During 2013-2018, the number of patients with AF undergoing PCI increased up to 1.3-fold (from 3,913 to 5,075 patients per year). After the introduction of NOACs, the proportion of dual antiplatelet therapy (DAPT) decreased from 71.9% to 49.8% but still occupied the largest proportion among antithrombotic regimens. Triple antithrombotic therapy (TAT) use increased from 25.4% to 46.0%, and NOAC has rapidly replaced warfarin as the oral anticoagulant of choice. TAT was preferred to DAPT for patients with CHA 2 DS 2 -VASc score ≥2. Among various factors, prior intracranial hemorrhage was the most powerful predictor of favoring DAPT use over TAT. Conclusion:Since the introduction of NOACs, the patterns of periprocedural antithrombotic regimens have changed rapidly toward more use of TAT, specifically with NOAC-based regimen. Appropriate stroke prevention with oral anticoagulants is still underutilized in patients with AF undergoing PCI in Korea.

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“…The authors considered that this might have been partly due to the relatively low prothrombin time–international normalized ratio (PT-INR) control (1.83 ± 0.41) in the study patients. Moreover, a nationwide Korean study showed the gradual increase in the prescription rate of TAT for patients with AF undergoing PCI [ 75 ]. Because the Japanese guideline recommends that a target PT-INR of 1.6–2.6 for patients with AF aged >70 years [ 76 , 77 ], a lower therapeutic level of warfarin with DAPT might be another option, especially for patients at high risk of thrombotic events including stent thrombosis.…”

Section: Optimal Antithrombotic Regimen In Patients With Af Undergmentioning

confidence: 99%

Antithrombotic Strategy for Patients with Acute Coronary Syndrome: A Perspective from East Asia

Numasawa

Sawano

Fukuoka

et al. 2020

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Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention has become the standard of care, particularly in patients with acute coronary syndrome (ACS). Current clinical guidelines recommend novel P2Y12 inhibitors (e.g., prasugrel or ticagrelor) in addition to aspirin based on the results of representative randomized controlled trials conducted predominantly in Western countries. These agents were superior to clopidogrel in reducing the composite ischemic events, with a trade-off of the increased bleeding events. However, multiple differences exist between East Asian and Western patients, especially with respect to their physique, thrombogenicity, hemorrhagic diathesis, and on-treatment platelet reactivity. Recent studies from East Asian countries (e.g., Japan or South Korea) have consistently demonstrated that use of novel P2Y12 inhibitors is associated with a higher risk of bleeding events than use of clopidogrel, despite borderline statistical difference in the incidence of composite ischemic events. Additionally, multiple studies have shown that the optimal duration of DAPT may be shorter in East Asian than Western patients. This review summarizes clinical studies of antithrombotic strategies in East Asian patients with ACS. Understanding these differences in antithrombotic strategies including DAPT and their impacts on clinical outcomes will aid in selection of the optimal tailored antithrombotic therapy for patients with ACS.

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Temporal trends in prevalence and antithrombotic treatment among Asians with atrial fibrillation undergoing percutaneous coronary intervention: A nationwide Korean population-based study

Cited by 23 publications

References 34 publications

Cardiovascular Research Using the Korean National Health Information Database

Cardiovascular Research Using the Korean National Health Information Database

Impact of Non-Vitamin K Antagonist Oral Anticoagulants on the Change of Antithrombotic Regimens in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Antithrombotic Strategy for Patients with Acute Coronary Syndrome: A Perspective from East Asia

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