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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation: Findings From

Felipe H Valle1, Shaun G Goodman1,2, Mary Tan2

  • 1Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

CJC Open
|January 7, 2022
PubMed

Insights

In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), dual-pathway therapy is used in about a quarter of cases, with increasing use over time. This therapy is chosen for patients with less complex coronary disease histories.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Balancing antithrombotic therapy risks (ischemia, stroke, bleeding) is crucial for atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI).
  • Understanding current treatment patterns is essential for optimizing patient care and outcomes in this high-risk population.

Purpose of the Study:

  • To determine the patterns of initial antithrombotic therapy selection in patients with AF undergoing PCI.
  • To analyze trends in the use of different antithrombotic regimens, including triple antithrombotic therapy (TAT) and dual-pathway therapy (DPT).

Main Methods:

  • A chart audit of 467 patients with AF undergoing PCI between December 2015 and July 2018 was conducted.
  • Data were collected by 47 Canadian cardiologists as part of the CONNECT AF+PCI study.
  • Initial antithrombotic therapy selection (TAT, DPT, dual antiplatelet therapy) was analyzed.

Main Results:

  • Triple antithrombotic therapy (TAT) was the initial choice for 62.7% of patients, followed by dual-pathway therapy (DPT) for 25.7%, and dual antiplatelet therapy for 11.6%.
  • Use of DPT showed a temporal increase during the study period.
  • Patients selected for DPT had less prior myocardial infarction and PCI but a higher prevalence of prior stroke/transient ischemic attack compared to those on TAT.

Conclusions:

  • Approximately one-quarter of AF patients undergoing PCI in Canadian practice receive dual-pathway therapy (DPT).
  • The utilization of DPT increased during the study period.
  • Patients receiving DPT generally presented with less complex coronary disease histories and interventions.
Abstract

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