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Anticoagulant and antiplatelet therapy in patients with atrial fibrillation undergoing percutaneous coronary

Koji Goto1, Kentaro Nakai1, Satoshi Shizuta1

  • 1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.

The American Journal of Cardiology
|June 14, 2014
PubMed

Insights

Oral anticoagulation (OAC) was underused and suboptimal in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI). This led to inadequate stroke prevention, highlighting a need for improved OAC management in real-world settings.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) require careful management of antithrombotic therapy.
  • The combined use of oral anticoagulation (OAC) and dual antiplatelet therapy (DAPT) presents challenges in balancing efficacy and safety.
  • Real-world data on OAC use in AF patients post-PCI is limited.

Purpose of the Study:

  • To evaluate the real-world prevalence, intensity, safety, and efficacy of OAC in patients with AF undergoing PCI.
  • To assess the impact of OAC use and its intensity (Time in Therapeutic Range - TTR) on stroke incidence.
  • To examine the outcomes of continuing DAPT alongside OAC in this patient population.

Main Methods:

  • Retrospective analysis of the Coronary REvascularization Demonstrating Outcome Study in Kyoto registry cohort-2.
  • Inclusion of 1,057 patients with AF undergoing first PCI.
  • Comparison of stroke incidence between OAC and no-OAC groups, and analysis of TTR and its association with outcomes.

Main Results:

  • AF patients had a higher 5-year stroke incidence (12.8%) compared to non-AF patients (5.8%).
  • OAC was underused (47.9% of eligible patients) and intensity was suboptimal, with a mean TTR of 52.6%.
  • Adequate TTR (≥65%) was associated with significantly lower stroke incidence (6.9% vs 15.1%).

Conclusions:

  • OAC is underutilized and inadequately managed in real-world AF patients post-PCI, leading to insufficient stroke prevention.
  • Suboptimal OAC intensity (low TTR) is linked to increased stroke risk.
  • Continuing long-term DAPT with OAC did not demonstrate a reduction in stroke incidence in this cohort.

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