Triple anticoagulation therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention – real life assessment

Abstract

IntroductionTriple anticoagulation therapy (TT), comprising dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC), is essential in atrial fibrillation (AF) patients after percutaneous coronary intervention (PCI), but it increases the bleeding risk.AimTo assess TT models, in- and out-hospital bleeding and thromboembolic complications, and TT alterations.Material and methodsDuring 12 months, consecutive AF post-PCI patients were scheduled for TT. Alterations in TT and thromboembolic events (death, myocardial infarction, ischemic stroke, in-stent thrombosis, peripheral embolization) were recorded. Major, non-major and minor bleeding episodes were assessed.ResultsOne hundred and thirty-six out of 3171 patients, aged 73.0 ±8.4 years (90 male), were included. Intra-hospitally, thrombotic events occurred in 9 (6.6%), while bleeding events occurred in 71 (52.2%) patients. Access-site hematoma and blood transfusions during in-hospital stay predisposed physicians to heparin administration as part of TT on discharge (p = 0.018 and p = 0.033 respectively). Eventually, DAPT plus warfarin or plus novel oral anticoagulant (NOAC) or plus low molecular weight heparin was prescribed in 72 (52.9%), 53 (39%), and 11 (8.1%) patients, respectively. HAS-BLED and CHA2DS2-VASc scores were similar between subgroups (p = 0.63 and p = 0.64 respectively). During 10.2 ±4.2 months of follow-up, 11 (8.1%) deaths, and 9 (6.6%) non-fatal thromboembolic events occurred. Bleeding events occurred in 45 (34.6%) patients, including 14 (10.3%) major. TT was the only factor associated with increased risk of major bleeding (18.6% vs. 4.2%, p = 0.008). Early termination of any TT component, which concerned 59 (45.4%) patients, did not increase the risk of thromboembolic events (p = 0.89).ConclusionsOur study indicates that TT is associated with high mortality and bleeding rates in a relatively short period of time. Discontinuation of any TT drug did not increase the thromboembolic event rate, while it was associated with reduced risk of major bleeding.

Effects of atrial fibrillation on complications and prognosis of patients receiving emergency PCI after acute myocardial infarction

“…If AMI patients are complicated with atrial fibrillation, the cardiac output may be further reduced, increasing ventricular rate, causing further imbalance between myocardial oxygen supply and demand, aggravating myocardial ischemia and hypoxia, and even expanding the infarct size, ultimately inducing and aggravating heart failure and even resulting in cardiac arrest in patients ( 10 ). Timely PCI is currently the most effective treatment method for AMI ( 11 ). At present, there is abundant literature worldwide mainly on research on prognosis of AMI patients complicated with atrial fibrillation, but literature on the effect of atrial fibrillation on PCI after AMI is scarce.…”

Thrombotic and hemorrhagic complications in atrial fibrillation patients, undergoing elective percutaneous coronary intervention

“…Проведение ЧКВ у больного ФП, имеющего высокий риск ТО, является основанием для назначения ТАТ. Учитывая различную скорость кровотока (низкую в ушке левого предсердия и высокую в коронарных артериях), патофизио-логический механизм образования тромба при ФП и в случае установки стента в просвет коронарной артерии отличается: в формировании тромба при ФП ведущую роль играют замедление кровотока и активация каскада коагуляции, при образовании тромба внутри стента -активация тромбоцитов [14,43]. Появление ППАКГ, а также результаты исследований ACTIVE W и AVERROES привели к тому, что в настоящее время возможность назначения антиагрегантной терапии с целью профилактики инсульта и системных эмболий больным ФП не рассматривается [1,6,12,13].…”

“…Данные сравнительного мета-анализа, а также исследований ACTIVE W и AVERROES продемонстрировали преимущество антикоагулянтов перед двойной антиагрегантной терапией при сопоставимой частоте кровотечений [11][12][13]. Замедление кровотока и активация факторов свертывания крови играют ведущую роль в формировании тромба при ФП, в то время как при образовании тромба внутри стента решающее значение имеет активация тромбоцитов [14]. Таким образом, проведение ЧКВ у больного ФП, имеющего высокий риск тромботических осложнений (ТО), является основанием для назначения тройной антитромботической терапии (ТАТ).…”

Expression of miR-1-3p, miR-16-5p and miR-122-5p as Possible Risk Factors of Secondary Cardiovascular Events

“…It is estimated that approximately 5.3 to 6.6% and 29% have recurrent MI at 1 and 5 years respectively, while the risk of recurrent stroke is about 10% at 1 year and 25% at 5 years [2,5,6].…”