scholarly journals Antithrombotic management of patients with acute coronary syndrome and atrial fibrillation undergoing coronary stenting: a prospective, observational, nationwide study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041044
Author(s):  
Leonardo De Luca ◽  
Andrea Rubboli ◽  
Leonardo Bolognese ◽  
Lucio Gonzini ◽  
Stefano Urbinati ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Antithrombotic Therapy ◽  
Multivariable Analysis ◽  
Bleeding Event ◽  
Coronary Stenting ◽  
Secondary Outcome ◽  
Pharmacological Management ◽  
Nationwide Study ◽  
Coronary Syndrome

ObjectiveThe aim of the study was to assess current management of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) undergoing coronary stenting.DesignNon-interventional, prospective, nationwide study.Setting76 private or public cardiology centres in Italy.ParticipantsPatients with ACS with concomitant AF undergoing percutaneous coronary intervention (PCI).Primary and secondary outcome measuresTo obtain accurate and up-to-date information on pharmacological management of patients with AF admitted for an ACS and undergoing PCI with stent implantation.ResultsOver a 12-month period, 598 consecutive patients were enrolled: 48.8% with AF at hospital admission and 51.2% developing AF during hospitalisation. At discharge, a triple antithrombotic therapy (TAT) was prescribed in 64.8%, dual antiplatelet therapy (DAPT) in 25.7% and dual antithrombotic therapy (DAT) in 8.8% of patients. Among patients with AF at admission, TAT and DAT were more frequently prescribed compared with patients with new-onset AF (76.3% vs 53.8% and 12.5% vs 5.3%, respectively; both p<0.0001), while a DAPT was less often used (11.2% vs 39.5%; p<0.0001). At multivariable analysis, a major bleeding event (OR: 5.40; 95% CI: 2.42 to 12.05; p<0.0001) and malignancy (OR: 5.11; 95% CI: 1.77 to 14.78; p=0.003) resulted the most important independent predictors of DAT prescription.ConclusionsIn this contemporary registry of patients with ACS with AF treated with coronary stents, TAT still resulted as the antithrombotic strategy of choice, DAT was reserved for high bleeding risk and DAPT was mainly prescribed in those developing AF during hospitalisation.Trial registration numberNCT03656523.

scholarly journals Double Antithrombotic versus Triple Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary Syndrome

2020 ◽  
Vol 29 (02) ◽  
pp. 081-087
Author(s):  
Surya Dharma
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Vitamin K ◽  
Antithrombotic Therapy ◽  
Randomized Clinical Trials ◽  
Bleeding Event ◽  
Vitamin K Antagonist ◽  
Thromboembolic Complications ◽  
Coronary Syndrome ◽  
Triple Antithrombotic Therapy

AbstractIn atrial fibrillation (AF), oral anticoagulant (OAC) therapy with either vitamin K antagonist or non–vitamin K antagonist is used to prevent thromboembolic complications. In patients who presented with acute coronary syndrome (ACS) and were treated by percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor reduces major adverse cardiac events (MACEs) and stent thrombosis. Consequently, in patients with AF who presented with ACS and were treated by PCI, the combination of OAC and DAPT, the so-called triple antithrombotic therapy (TAT) is needed to improve the outcome of the patients. However, the use of TAT increases the risk of bleeding. Several randomized clinical trials and a meta-analysis evaluated the use of TAT and double antithrombotic therapy (DAT) in this population, and DAT is defined as patients who receive combination of one antiplatelet and OAC. In general, the studies demonstrated a reduction in bleeding event in patients who received DAT as compared with TAT, with similar incidence of thromboembolic complications and MACE. To date, there is no established consensus or guideline for the most appropriate combination of antithrombotic agents in patients with AF and ACS who undergo PCI. Tailoring the treatment for each individual is likely the best approach to determine the balance of bleeding risk and ischemic events before starting antithrombotic therapy. Future trials with adequate sample size are needed to find the most appropriate combination of antiplatelet and OAC in patients with AF who presented with ACS and treated by PCI.

Antithrombotic therapy: triple therapy or triple threat?

Hematology ◽  
2012 ◽  
Vol 2012 (1) ◽  
pp. 547-552 ◽  
Author(s):  
Jessica Mega ◽  
Edward T. Carreras
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Observational Studies ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Risks And Benefits ◽  
Percutaneous Coronary ◽  
Pharmacokinetic Properties

Abstract Antithrombotic therapy plays an essential role in the management of some of the most common and morbid medical conditions. Triple oral antithrombotic therapy (TOAT) is defined as the administration of both therapeutic oral anticoagulation (OAC) and dual antiplatelet therapy (DAPT) to patients with indications for both treatments. The current societal guidelines regarding TOAT are derived from observational studies and some trials of the use of warfarin in addition to antiplatelet therapy in patients with atrial fibrillation and a recent acute coronary syndrome or percutaneous coronary intervention. The general apprehension to administer TOAT is due to the heightened concern for bleeding, rendering warfarin's pharmacokinetic properties concerning. Newer anticoagulant agents may serve as appealing alternatives, and further investigations are warranted. The results of the recent trials that have studied the use of these agents in atrial fibrillation and acute coronary syndrome offer some useful applications to TOAT. Ultimately, selecting the most favorable antithrombotic strategy is going to involve weighing the risks and benefits for each patient.

scholarly journals Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation

2019 ◽  
Vol 380 (16) ◽  
pp. 1509-1524 ◽  
Author(s):  
Renato D. Lopes ◽  
Gretchen Heizer ◽  
Ronald Aronson ◽  
Amit N. Vora ◽  
Tyler Massaro ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Antithrombotic Therapy ◽  
Coronary Syndrome

Efficacy and safety of new oral anticoagulants as part of triple antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome. Data from an observational study

Kardiologiia ◽  
2020 ◽  
Vol 60 (7) ◽  
pp. 53-63
Author(s):  
N. A. Sycheva ◽  
L. Yu. Koroleva ◽  
V. P. Nosov ◽  
G. V. Kovaleva ◽  
N. N. Paikova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Treatment Group ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Coronary Syndrome ◽  
Warfarin Treatment ◽  
Ischemic Events ◽  
Triple Antithrombotic Therapy

Aim To study efficacy and safety of a triple antithrombotic therapy with direct oral anticoagulants (DOAC) versus warfarin in patients with atrial fibrillation after acute coronary syndrome, for 12 months following discharge from the hospital.Materials and methods This single-site cohort, prospective, observational study performed at the Regional Vascular Center 2 of the N.A. Semashko Nizhniy Novgorod Regional Clinical Hospital included 402 patients. It was possible to maintain contacts with 206 patients for 12 months. These patients were divided into two groups, the DOAC treatment (n=105) and the warfarin treatment (n=101) as a part of triple antithrombotic therapy upon discharge. Clinical observation was performed at 1, 3, 6, and 12 months after the discharge by structured telephone interview. Predetermined efficacy endpoints included cardiovascular death, myocardial infarction, stent thrombosis, and ischemic stroke. Safety endpoints included bleeding defined as small, medium (clinically significant), and major in accordance with the TIMI classification.Results At 12 months of follow-up, 80 patients (76.19%) continued taking DOAC and 39 patients (38.61%, p<0.001) continued taking warfarin; in this process, only 25 patients (24.75%) monitored their INR on a regular basis. With a regular INR monitoring and TTR >70%, death rate did not differ in the warfarin and the DOAC treatment groups. However, there was a difference in reaching the composite efficacy endpoint (p=0.048): ischemic events occurred statistically significantly more frequently in the warfarin treatment group than in the DOAC treatment group.Conclusions In 12 months after discharge from the hospital, compliance with the DOAC treatment as a part of the antithrombotic therapy was significantly higher than compliance with the warfarin treatment. The triple antithrombotic therapy with DOAC was safer than the warfarin treatment by the number of hemorrhagic complications and more effective in prevention of ischemic events, primarily due to no need for monitoring of lab test values.

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