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Anticoagulation in patients with atrial fibrillation undergoing coronary stent implantation

A Bernard1, L Fauchier, C Pellegrin

  • 1Laurent Fauchier, MD, Service de Cardiologie B et Laboratoire d'Electrophysiologie Cardiaque, Pole Cœur Thorax Vasculaire Hémostase, Centre Hospitalier Universitaire Trousseau, 37044 Tours, France, Tel.: +33 2 47 47 46 50, Fax: +33 2 47 47 59 19,

Thrombosis and Haemostasis
|July 13, 2013
PubMed

Insights

For atrial fibrillation patients with high thromboembolic risk after coronary stent implantation, oral anticoagulation (OAC) use was linked to a reduced risk of death or stroke. Systematic OAC use is suggested for this high-risk group.

Area of Science:

  • Cardiology
  • Pharmacology
  • Thrombosis Research

Background:

  • Optimal antithrombotic strategy remains unclear for atrial fibrillation (AF) patients needing coronary stent implantation.
  • Patients with AF and high thromboembolic risk (CHA2DS2-VASC score ≥ 2) undergoing stenting require specific management considerations.

Purpose of the Study:

  • To evaluate the association between oral anticoagulation (OAC) use and morbidity/mortality in AF patients with high thromboembolic risk post-coronary stent implantation.
  • To determine if OAC confers a benefit in preventing major adverse cardiac events in this specific patient cohort.

Main Methods:

  • Retrospective analysis of 8,962 AF patients (2000-2010), focusing on 417 with coronary artery disease, stent implantation, and CHA2DS2-VASC score ≥ 2.
  • Follow-up for thromboembolic events (TE), bleeding, and major adverse cardiac events (death, myocardial infarction, revascularization).
  • Multivariate analysis to identify independent predictors of adverse outcomes, comparing patients with and without OAC at discharge.

Main Results:

  • 23% of eligible patients received OAC at discharge; OAC use was higher in permanent AF and elective stenting.
  • Initial event rates were not significantly different between OAC and non-OAC groups.
  • Lack of OAC was independently associated with increased risk of death/stroke/systemic TE (RR=2.18, p=0.04), alongside older age, heart failure, and prior stroke.

Conclusions:

  • In AF patients with high thromboembolic risk after coronary stenting, OAC use is independently associated with a decreased risk of death, stroke, and systemic TE.
  • Findings suggest that oral anticoagulation should be systematically considered and utilized in this high-risk patient population.

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