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Published on: February 26, 2013
Triple anticoagulation therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention -
Paweł Bogacki1, Anna Kabłak-Ziembicka1, Krzysztof Bryniarski1
1Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
Insights
Triple anticoagulation therapy (TT) in atrial fibrillation patients post-PCI leads to high bleeding and mortality rates. Stopping TT components reduced major bleeding without increasing thromboembolic events.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Triple anticoagulation therapy (TT), combining dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC), is crucial for atrial fibrillation (AF) patients after percutaneous coronary intervention (PCI).
- However, TT significantly elevates bleeding risk, necessitating careful management and assessment of therapeutic models.
Purpose of the Study:
- To evaluate different TT models in AF patients post-PCI.
- To assess in-hospital and out-of-hospital bleeding and thromboembolic complications associated with TT.
- To analyze alterations in TT regimens and their impact on patient outcomes.
Main Methods:
- A prospective study included 136 AF patients post-PCI scheduled for TT over 12 months.
- Data collected included TT alterations, thromboembolic events (death, MI, stroke, thrombosis), and bleeding episodes (major, non-major, minor).
- Statistical analysis compared outcomes between different TT strategies and evaluated factors influencing bleeding and thrombosis.
Main Results:
- In-hospital, 6.6% experienced thrombotic events and 52.2% had bleeding complications.
- During follow-up (10.2 months), 8.1% died, and 6.6% had non-fatal thromboembolic events.
- Major bleeding occurred in 10.3% of patients; TT was the sole factor linked to increased major bleeding risk (18.6% vs. 4.2%).
Conclusions:
- TT in AF patients post-PCI is associated with substantial short-term mortality and bleeding rates.
- Early discontinuation of any TT component did not elevate thromboembolic risk.
- Stopping TT drugs was linked to a reduced risk of major bleeding, suggesting a potential strategy for risk mitigation.
Introduction:
Triple anticoagulation therapy (TT), comprising dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC), is essential in atrial fibrillation (AF) patients after percutaneous coronary intervention (PCI), but it increases the bleeding risk.
Aim:
To assess TT models, in- and out-hospital bleeding and thromboembolic complications, and TT alterations.
Material And Methods:
During 12 months, consecutive AF post-PCI patients were scheduled for TT. Alterations in TT and thromboembolic events (death, myocardial infarction, ischemic stroke, in-stent thrombosis, peripheral embolization) were recorded. Major, non-major and minor bleeding episodes were assessed.
Results:
One hundred and thirty-six out of 3171 patients, aged 73.0 ±8.4 years (90 male), were included. Intra-hospitally, thrombotic events occurred in 9 (6.6%), while bleeding events occurred in 71 (52.2%) patients. Access-site hematoma and blood transfusions during in-hospital stay predisposed physicians to heparin administration as part of TT on discharge (p = 0.018 and p = 0.033 respectively). Eventually, DAPT plus warfarin or plus novel oral anticoagulant (NOAC) or plus low molecular weight heparin was prescribed in 72 (52.9%), 53 (39%), and 11 (8.1%) patients, respectively. HAS-BLED and CHA2DS2-VASc scores were similar between subgroups (p = 0.63 and p = 0.64 respectively). During 10.2 ±4.2 months of follow-up, 11 (8.1%) deaths, and 9 (6.6%) non-fatal thromboembolic events occurred. Bleeding events occurred in 45 (34.6%) patients, including 14 (10.3%) major. TT was the only factor associated with increased risk of major bleeding (18.6% vs. 4.2%, p = 0.008). Early termination of any TT component, which concerned 59 (45.4%) patients, did not increase the risk of thromboembolic events (p = 0.89).
Conclusions:
Our study indicates that TT is associated with high mortality and bleeding rates in a relatively short period of time. Discontinuation of any TT drug did not increase the thromboembolic event rate, while it was associated with reduced risk of major bleeding.
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