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Published on: February 28, 2012
Real-World Antithrombotic Therapy in Atrial Fibrillation Patients with a History of Percutaneous Coronary
Ai Horiguchi1, Hidehira Fukaya1, Jun Oikawa1
1Department of Cardiovascular Medicine, Kitasato University School of Medicine.
Insights
Antithrombotic therapy for atrial fibrillation patients post-percutaneous coronary intervention is shifting. Oral anticoagulants (OACs) are increasingly used, with a decrease in triple therapy and a rise in OAC monotherapy, though evidence for the latter is limited.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Optimal antithrombotic strategy for atrial fibrillation (AF) patients with a history of percutaneous coronary intervention (PCI) remains debated.
- Current prescription trends for these patients, particularly in the chronic phase, are not well-defined.
Purpose of the Study:
- To analyze the evolving trends in antithrombotic therapy prescription for patients with both AF and a history of PCI.
- To evaluate the shift in the use of oral anticoagulants (OACs), direct oral anticoagulants (DOACs), and dual/triple therapy regimens over time.
Main Methods:
- Retrospective evaluation of 266 AF patients with at least a 1-year history of PCI.
- Data collected across multiple time points: 2010, 2012, 2014, and 2016.
- Analysis of prescription patterns including OACs, DOACs, single antiplatelet therapy (SAPT), and triple therapy (dual antiplatelet therapy with OAC).
Main Results:
- The proportion of patients on OACs increased from 56% in 2010 to 74% in 2016.
- The use of DOACs rose significantly compared to warfarin after DOACs' launch in 2011.
- Single antiplatelet therapy with OAC became the most common regimen, increasing from 41% to 59%.
- OAC monotherapy proportion grew from 2% to 9%, while triple therapy decreased from 14% to 5%.
Conclusions:
- Antithrombotic therapy for AF patients with prior PCI shows significant annual changes.
- A clear trend towards decreased triple therapy and increased OAC monotherapy was observed between 2010 and 2016.
- Further evidence is needed to support the safety and efficacy of OAC monotherapy in this patient population.
Abstract:
Optimal antithrombotic strategy for atrial fibrillation (AF) patients with a history of percutaneous coronary intervention (PCI) has been under debate. The actual prescription trend of antithrombotic therapy for these patients remains unclear, especially in chronic phase.Patients with AF having at least a 1-year history of PCI were retrospectively evaluated in 2010, 2012, 2014, and 2016. A total of 266 patients were finally enrolled in this study. The proportion of patients prescribed with oral anticoagulants (OACs) gradually increased over the study period (56%, 67%, 73%, and 74% in 2010, 2012, 2014, and 2016, respectively). According to the type of OACs, the proportion of direct oral anticoagulant (DOAC), launched in 2011, increased compared with warfarin (DOAC versus warfarin = 3% versus 64% in 2012, 24% versus 49% in 2014, and 32% versus 42% in 2016). Single antiplatelet therapy (SAPT) with OAC was the most popular prescription every year, and its proportion increased over the study period (41%, 44%, 55%, and 59%, respectively). The proportion of OAC monotherapy gradually increased (2%, 3%, 8%, and 9%, respectively), whereas that of triple therapy, i.e., dual antiplatelet therapy with OAC, gradually decreased (14%, 22%, 8%, and 5% in 2010, 2012, 2014, and 2016, respectively).Antithrombotic therapy trends for AF patients with a history of PCI were changing every year. The prescription rate of triple therapy gradually decreased, in contrast, that of OAC monotherapy gradually increased from 2010 to 2016. However, the evidence for OAC monotherapy in these patients remains insufficient.
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