Comparative effectiveness and safety of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome or percutaneous coronary intervention
Journal
Acta Cardiologica Sinica
Journal Volume
35
Journal Issue
5
Date Issued
2019
Author(s)
Abstract
© 2019, Republic of China Society of Cardiology. All rights reserved. Background: There remains insufficient evidence to determine the optimal antithrombotic strategy in atrial fibrillation (AF) patients presenting with acute coronary syndrome (ACS) or percutaneous coronary interventions (PCIs), especially in Asian populations. Objectives: This study aimed to examine the real-world patterns of antithrombotic treatment among these patients and to compare the effectiveness and safety of different antithrombotic regimens. Methods: A retrospective cohort study was conducted in AF patients presenting with a new ACS or PCI during 2006/1/1-2016/4/1. Three antithrombotic regimenswere compared: Dual antiplatelet therapy (DAPT, as the reference group), triple therapy (TT: DAPT plus an oral anticoagulant), and dual therapy (DT: Single antiplatelet plus an oral anticoagulant). The outcomes of interest were major adverse cardiac and cerebrovascular events (MACCEs) and bleeding. Treatment effectwas estimated using a Cox proportional hazards model. Inverse probability of treatment weighting was used to balance baseline characteristics among comparison groups. Results: Overall, 532 patients were included. At discharge from the index hospitalization, DAPT was the most common antithrombotic therapy, followed by TT and DT. No significant difference inMACCEswas found among the different antithrombotic regimens. However, DT was associated with a lower risk of any bleeding [adjusted hazard ratio 0.20 (95% confidence interval, 0.06-0.75)] than DAPT. Conclusions: In the study population, DAPTwas the most commonly prescribed antithrombotic regimen for cardiocerebrovascular disease prevention. The effectiveness outcomeswere comparable across different antithrombotic strategies. The lower risk of bleeding with DT compared with DAPT warrants further investigation.
Subjects
Acute coronary syndrome | Anticoagulants | Atrial fibrillation | Percutaneous coronary intervention | Platelet aggregation inhibitors
Acute coronary syndrome; Anticoagulants; Atrial fibrillation; Percutaneous coronary intervention; Platelet aggregation inhibitors
SDGs
Other Subjects
acetylsalicylic acid; angiotensin receptor antagonist; anticoagulant agent; antithrombocytic agent; antivitamin K; dipeptidyl carboxypeptidase inhibitor; hemoglobin; nonsteroid antiinflammatory agent; purinergic receptor blocking agent; warfarin; acute coronary syndrome; acute heart infarction; adult; aged; antithrombotic activity; Article; atrial fibrillation; bleeding; body mass; brain hemorrhage; cerebrovascular disease; cohort analysis; comparative effectiveness; coronary artery bypass graft; drug exposure; dual antiplatelet therapy; electrocardiogram; female; follow up; HAS BLED score; heart failure; heart infarction; heart left ventricle ejection fraction; human; ICD-10-CM; ICD-9-CM; major adverse cardiac event; major clinical study; male; middle aged; outcome assessment; percutaneous coronary intervention; percutaneous transluminal angioplasty; retrospective study; ST segment elevation myocardial infarction; target vessel revascularization; transient ischemic attack
Type
journal article