Dual Antithrombotic Therapy with Clopidogrel and Novel Oral Anticoagulants in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Real-world Study

The article presents an analytical review of the studies aimed at determining the optimal antithrombotic therapy in patients with atrial fibrillation undergoing elective or emergency percutaneous coronary intervention (PCI) due to the development of acute coronary syndrome (ACS). The results of the WOEST study are analysed. This study was the first to demonstrate an opportunity to safely discontinue administration of aspirin as part of the multicomponent antithrombotic therapy that included warfarin as an anticoagulant. Three studies were analysed - PIONEER AF-PCI, RE-DUAL-PCI and AUGUSTUS, where direct oral anticoagulants (DOACs) - rivaroxaban, dabigatran and apixaban were used as anticoagulants as part of the multicomponent therapy. The results of these studies formed the backbone of the updated European guidelines for the diagnosis and treatment of atrial fibrillation, 2020. The guidelines offer to divide patients with AF and ACS, who require multicomponent antithrombotic therapy, into two categories. The first group includes AF patients with uncomplicated PCI without a high risk of stent thrombosis, as well as patients with a risk of bleeding that prevails over the risk of stent thrombosis. The second category of patients, in contrast, is characterized by a high risk of stent thrombosis, which prevails over the risk of bleeding. In the absence of contraindications, the patients of both categories should choose DOAC as an anticoagulant and be prescribed clopidogrel as a P2Y12 inhibitor for 12 months. In AF patients with uncomplicated PCI without a high risk of stent thrombosis, as well as in patients with a risk of bleeding, which prevails over the risk of stent thrombosis, the period of treatment with the second antiplatelet drug (aspirin) should belimited to the hospital stay. Patients at increased risk of stent thrombosis and reduced risk of bleeding can extend the aspirin therapy for 1 month. The approaches to the choice of the duration and composition of the multicomponent antithrombotic therapy in AF patients taking oral anticoagulants after elective PCI are similar to those in ACS patients, except for the duration of clopidogrel therapy, which is reduced to 6 months in all patients.

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Meta-analysis of antithrombotic therapy with new oral anticoagulants in patients with atrial fibrillation after percutaneous coronary intervention

European Journal of Preventive Cardiology ◽

10.1177/2047487319865048 ◽

2019 ◽

Vol 27 (19) ◽

pp. 2119-2122

Author(s):

Rabbia Siddiqi ◽

Naser Yamani ◽

Saed Alnaimat ◽

Aiman Khurshid ◽

Sadia Siddiqui ◽

...

Keyword(s):

Atrial Fibrillation ◽

Percutaneous Coronary Intervention ◽

Antithrombotic Therapy ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Coronary Intervention ◽

New Oral Anticoagulants ◽

Percutaneous Coronary

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Atrial fibrillation patients undergoing percutaneous coronary intervention: dual or triple antithrombotic therapy with non-vitamin K antagonist oral anticoagulants

European Heart Journal Supplements ◽

10.1093/eurheart/suaa101 ◽

2020 ◽

Vol 22 (Supplement_I) ◽

pp. I22-I31

Author(s):

Andreas Goette ◽

Pascal Vranckx

Keyword(s):

Atrial Fibrillation ◽

Percutaneous Coronary Intervention ◽

Triple Therapy ◽

Vitamin K ◽

Antithrombotic Therapy ◽

Oral Anticoagulants ◽

Coronary Intervention ◽

Vitamin K Antagonist ◽

Percutaneous Coronary ◽

The Impact

Abstract About 20% of all atrial fibrillation (AF) patients develop coronary artery disease, which requires coronary stenting [percutaneous coronary intervention (PCI)]. Thus, this subcohort of AF patients may require aggressive antithrombotic therapy encompassing vitamin K antagonist (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC) plus aspirin and a P2Y12 inhibitor. At present, four clinical Phase IIIb trials using dabigatran, rivaroxaban, apixaban, or edoxaban, were published. These studies assessed the impact of NOACs as a part of DAT therapy vs. triple therapy. Compared with triple therapy, NOAC-based DAT has been shown to be associated with reduced major bleeding as well as intracranial haemorrhages. The benefit, however, is somewhat counterbalanced by a higher risk of stent-related ischaemia during the early phase of dual therapy. Thus, triple therapy after stenting is appropriate for at least 14 days with a maximum of 30 days. Thereafter, DAT including a NOAC is the therapy of choice in AF PCI patients to reduce the risk of bleeding during a 1 year of follow-up compared to VKA-based regimes. The present review summarizes the published study results and demonstrates differences in trial design and reported outcomes.

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Modern strategy of antithrombotic therapy in patients with coronary artery disease and atrial fibrillation after percutaneous coronary intervention

Russian Journal of Cardiology ◽

10.15829/1560-4071-2019-12-137-147 ◽

2019 ◽

pp. 137-147

Author(s):

Yu. A. Karpov

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Antithrombotic Therapy ◽

Oral Anticoagulants ◽

Coronary Intervention ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Artery Disease

Reducing of cardiovascular risk, morbidity and mortality is considered as one of the main aims of modern cardiology, which should help increase life expectancy. Oral anticoagulants are the basis for the cardioembolic stroke prevention in patients with atrial fibrillation, which is common in patients with coronary artery disease. According to statistics, about a quarter of patients with atrial fibrillation have to perform percutaneous coronary intervention at some point in their life. This is due to stable angina or acute coronary syndrome, which is accompanied by difficulties with antithrombotic therapy. This article discusses the main clinical data and recommendations on the optimal use of combination antithrombotic therapy in patients after percutaneous coronary intervention.

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Real-World Antithrombotic Therapy in Atrial Fibrillation Patients with a History of Percutaneous Coronary Intervention

International Heart Journal ◽

10.1536/ihj.19-127 ◽

2019 ◽

Vol 60 (6) ◽

pp. 1321-1327 ◽

Cited By ~ 1

Author(s):

Ai Horiguchi ◽

Hidehira Fukaya ◽

Jun Oikawa ◽

Yuki Shirakawa ◽

Shuhei Kobayashi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Percutaneous Coronary Intervention ◽

Real World ◽

Antithrombotic Therapy ◽

Coronary Intervention ◽

Percutaneous Coronary ◽

History Of

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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

Journal of Clinical Medicine ◽

10.3390/jcm10071505 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1505

Author(s):

Jiesuck Park ◽

Jin-Hyung Jung ◽

Eue-Keun Choi ◽

Seung-Woo Lee ◽

Soonil Kwon ◽

...

Keyword(s):

Atrial Fibrillation ◽

Percutaneous Coronary Intervention ◽

Vitamin K ◽

Antithrombotic Therapy ◽

Oral Anticoagulants ◽

Coronary Intervention ◽

Population Based ◽

Longitudinal Patterns ◽

Percutaneous Coronary

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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