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Updated: Dec 17, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
[Thrombotic and hemorrhagic complications in atrial fibrillation patients, undergoing elective percutaneous coronary
E N Krivosheeva1, E S Kropacheva1, E P Panchenko1
1National Medical Research Center for Cardiology.
Insights
Reduced doses of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) increased thrombotic events. Hemorrhagic complications remained comparable between reduced and full DOAC doses.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) often require antithrombotic therapy.
- Direct oral anticoagulants (DOACs) are increasingly used, but optimal dosing in the context of triple antithrombotic therapy (TAT) remains a concern.
Purpose of the Study:
- To evaluate the efficacy and safety of reduced-dose DOACs within TAT for AF patients undergoing elective PCI.
- To identify factors associated with the use of reduced-dose DOACs in this patient population.
Main Methods:
- A cohort analysis of AF patients who underwent elective PCI and received DOACs as part of TAT.
- Assessment of composite efficacy endpoints (thrombotic events) and safety endpoints (hemorrhagic complications) using the Log-Rank criterion.
Main Results:
- Half of the high-risk AF patients received reduced DOAC doses.
- Reduced DOAC doses were associated with a significant increase in thrombotic events (p=0.0292).
- Hemorrhagic complications (BARC types 2-5) were comparable between reduced and full DOAC dose groups (p=0.06742).
Conclusions:
- Reduced DOAC doses in AF patients undergoing PCI as part of TAT significantly increase thrombotic event incidence.
- The safety profile regarding hemorrhagic complications was similar between reduced and full DOAC doses.
Aim:
To evaluate efficacy and safety of reduced dose of direct oral anticoagulants (DOACs) as part of triple antithrombotic therapy in AF patients, undergoing elective percutaneous coronary intervention (PCI), and to identify factors, associated with this strategy.
Materials And Methods:
The study is a cohort analysis of AF patients with AF, who successfully underwent elective PCI and assigned DOACs as part of triple antithrombotic therapy (TAT).Influence of a reduced DOACs dose as a part of TAT on the frequency of thecomposite efficacy endpoint (acute coronary syndrome, ischemic stroke, venous thromboembolic events, cardiovascular death and angina pectoris aggravation/need for unplanned PCI) and safety endpoint (hemorrhagic complications BARC types 2-5) were assessed using the Log-Rank criterion.
Results:
The study included 124 pts (69.4% women, mean aged 69±8.2 years). Themedian total score CHA2DS2-VASc was 5, the median of the Charlson index composed 7. Half (52%) of AF patients with high risk of thrombotic events after elective PCI received reduced-DOACs dose. Median follow up period was 11.0 month. 17 adverse thrombotic events were recorded during this period, BARC 2-5 bleedings occurred in 27 patients. Reduced DOACs doses in AF patients undergoing PCI were associated with significant increase of thrombotic events during follow up period compared to patients received full DOACs doses (0.79 vs 0.93, Log-Rank p=0.0292). Patients, who received full and reduced DOAC doses, were comparable in the frequency of BARC 2-5 bleedings (0.78 vs 0.75, Log-Rank p=0.06742).
Conclusions:
The administration of a reduced DOACs dose as a part of TAT in patients with AF, who underwent PCI, was associated with significant increase in the incidence of all thrombotic events, compared to patients, who received full dose of anticoagulants. The number of hemorrhagic complications was comparable.
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