Related Experiment Video
Updated: Oct 18, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Treatment Pattern of Antithrombotic Therapy over Time after Percutaneous Coronary Intervention in Patients with
Seongwook Han1, Sola Han2, Sung-Won Jang3
1Division of Cardiology, Department of Internal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea.
Insights
Antithrombotic therapy patterns in atrial fibrillation (AF) patients post-percutaneous coronary intervention (PCI) show significant deviations from guidelines. Real-world practice often involves shorter durations of triple therapy than recommended.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) require careful antithrombotic management to balance ischemic and bleeding risks.
- Current guidelines recommend specific antithrombotic strategies, but real-world adherence and treatment patterns remain incompletely understood.
- Understanding treatment variations is crucial for optimizing patient outcomes in this high-risk population.
Purpose of the Study:
- To investigate antithrombotic treatment patterns and therapy changes in patients with AF following PCI.
- To compare real-world treatment practices against established clinical guidelines.
- To identify factors influencing therapy selection and duration in this patient cohort.
Main Methods:
- Retrospective analysis of a Korean national health insurance claims database (2007-2016).
- Inclusion criteria: adult patients with AF (ICD code: I48) who underwent PCI with stenting and received antithrombotics prior to or on the day of PCI, with a CHADS2-VASc score of ≥2.
- Analysis of prescribed antithrombotic therapies: triple therapy, dual therapy, dual antiplatelet therapy (DAPT), and single antiplatelet therapy.
Main Results:
- Among 7749 AF patients post-PCI, dual antiplatelet therapy (DAPT) was most common (60.8%), followed by single antiplatelet therapy (11.0%), triple therapy (24.6%), and dual therapy (3.4%).
- Triple therapy duration was short, with a median of 55-87 days, and only 23.1% persisted for 12 months.
- DAPT use for 12 months was common (62.6%) in the DAPT group, with a median duration of 324-345 days.
Conclusions:
- A significant gap exists between current antithrombotic treatment guidelines and actual clinical practice for AF patients undergoing PCI.
- Real-world data suggest suboptimal adherence to recommended triple therapy durations and patterns.
- Emphasis on the appropriate use of anticoagulants in conjunction with antiplatelet therapy is warranted to improve patient care.
Abstract:
We examined antithrombotic treatment patterns with clinical characteristics and therapy changes over time in patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). Using the Health Insurance Review and Assessment service claims database (01JAN2007-30NOV2016) in Korea, we included adult patients with AF and PCI: (1) who underwent PCI with stenting between 01JAN2008 and 30NOV2016; (2) with ≥1 claim for AF (ICD code: I48) (3) with antithrombotics 1 day prior to or at the date of PCI; and (4) with CHADS2-VASc of ≥2. In this study, 7749 patients with AF who underwent PCI, triple therapy, dual therapy, dual antiplatelet therapy (DAPT), and single antiplatelet therapy were prescribed to 24.6%, 3.4%, 60.8%, and 11.0%, respectively. In the triple therapy group, 23.1% persisted with triple therapy for 12 months, whereas the remaining patients switched to a different therapy. In the entire cohort and several subgroups, the median treatment duration of triple therapy was 55-87 days. DAPT use for 12 months was the most common treatment pattern (62.6%) in the DAPT group (median treatment duration, 324-345 days). A significant discrepancy exists between the current guidelines and real-world practice regarding antithrombotic treatment with PCI for patients with AF. Appropriate use of anticoagulants should be emphasized.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:27Coronary Artery Disease V: Interprofessional Care
01:25Dysrhythmias VI: Management of Dysrhythmias
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins