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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Antithrombotic treatment beyond 1 year after percutaneous coronary intervention in patients with atrial fibrillation

Thomas Jensen1, Pernille G Thrane1, Kevin K W Olesen1

  • 1Department of Cardiology, Aarhus University Hospital, Aarhus 8200, Denmark.

European Heart Journal. Cardiovascular Pharmacotherapy
|October 21, 2022
PubMed

Insights

Long-term anticoagulant monotherapy after percutaneous coronary intervention (PCI) in atrial fibrillation (AF) patients is as safe as dual therapy. Direct oral anticoagulant (DOAC) monotherapy is also as effective as vitamin K antagonist (VKA) therapy.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Guidelines recommend anticoagulant monotherapy over dual therapy post-percutaneous coronary intervention (PCI) in atrial fibrillation (AF) patients beyond 1 year.
  • The safety and efficacy of long-term anticoagulant strategies after PCI in AF patients remain uncertain.

Purpose of the Study:

  • To compare hospitalization risks for bleeding and ischemic events between anticoagulant monotherapy and dual therapy beyond 1 year post-PCI in AF patients.
  • To compare direct oral anticoagulant (DOAC) and vitamin K antagonist (VKA) monotherapy in terms of bleeding and ischemic risk beyond 1 year post-PCI in AF patients.

Main Methods:

  • Retrospective analysis of AF patients undergoing first-time PCI between 2003-2017 from the Western Denmark Heart Registry.
  • Follow-up initiated 15 months post-PCI, assessing outcomes up to 4 years using Cox regression models.
  • Comparison of monotherapy vs. dual therapy (n=3331) and DOAC vs. VKA monotherapy (n=1275).

Main Results:

  • No significant difference in bleeding hospitalization (HRw 0.90) or major adverse cardiac events (MACE) (HRw 1.04) between monotherapy and dual therapy.
  • Similar risks for bleeding hospitalization (HRw 1.27) and MACE (HRw 1.15) between DOAC and VKA monotherapy.

Conclusions:

  • Long-term oral anticoagulant monotherapy is supported beyond 1 year post-PCI in AF patients.
  • DOAC monotherapy demonstrates comparable safety and efficacy to VKA monotherapy in this patient population.
Abstract

Keywords:
Atrial fibrillationBleedingCohort studyPercutaneous coronary interventionThromboembolism

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