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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Outcomes in relation to antithrombotic therapy among patients with atrial fibrillation after percutaneous coronary

Jiesuck Park1, Eue-Keun Choi1, Kyung-Do Han2

  • 1Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

Plos One
|October 15, 2020
PubMed

Insights

For atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI), oral anticoagulant plus antiplatelet therapy (OAC±SAPT) showed better 1-year outcomes than triple therapy (TT) or antiplatelets alone (APT). This regimen reduced composite ischemic and bleeding events post-PCI.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) require careful antithrombotic management.
  • The optimal antithrombotic strategy beyond one year post-PCI in AF patients remains an area of active investigation.

Purpose of the Study:

  • To evaluate the prognostic impact of different antithrombotic regimens at one year after PCI in patients with AF.
  • To compare the risks of ischemic events and bleeding complications among various antithrombotic strategies in this high-risk population.

Main Methods:

  • A retrospective cohort study utilizing the Korean National Health Insurance Service database.
  • Included 13,278 AF patients who underwent PCI between 2009 and 2013.
  • Patients were classified into three groups at 1-year post-PCI: OAC with or without single antiplatelet (OAC±SAPT), triple therapy (TT), and antiplatelets only (APT). Propensity score matching was employed for comparison.

Main Results:

  • Compared to OAC±SAPT, triple therapy (TT) was associated with a significantly higher risk of composite clinical outcomes (ischemia and bleeding).
  • The antiplatelets only (APT) group demonstrated a higher risk of ischemic events but a lower risk of bleeding events compared to the OAC±SAPT group.
  • Oral anticoagulant plus single antiplatelet therapy (OAC±SAPT) showed a favorable balance of efficacy and safety.

Conclusions:

  • Oral anticoagulant plus single antiplatelet therapy (OAC±SAPT) was associated with superior clinical outcomes compared to triple therapy (TT) or antiplatelets only (APT) beyond one year post-PCI.
  • These findings suggest OAC±SAPT as a potentially preferred antithrombotic strategy for Asian patients with AF after PCI.
Abstract

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