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Utilization of triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary

Hye-Jeong Choi1, Yonghyuk Lee1, Susin Park2

  • 1College of Pharmacy, Pusan National University, Busandaehakro 63 Bungil 2, Geumjeong-Gu, Busan, 46241, Republic of Korea.

European Journal of Clinical Pharmacology
|February 24, 2023
PubMed

Insights

Triple antithrombotic therapy (TAT) use increased significantly for atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) from 2011 to 2020. However, many patients still did not receive optimal antithrombotic treatment.

Area of Science:

  • Cardiology
  • Pharmacology
  • Health Services Research

Background:

  • Triple antithrombotic therapy (TAT), combining oral anticoagulants and dual antiplatelet therapy (DAPT), is crucial for preventing ischemic events in atrial fibrillation (AF) patients post-percutaneous coronary intervention (PCI).
  • Concerns regarding bleeding risk limit the widespread adoption of TAT.
  • This study investigates TAT utilization and its determinants in the era of non-vitamin K antagonist oral anticoagulants (NOACs) using real-world data.

Purpose of the Study:

  • To analyze the trends in utilization of triple antithrombotic therapy (TAT) among patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).
  • To identify demographic and clinical factors influencing the adoption of TAT in the NOACs era.
  • To assess the adequacy of antithrombotic therapy in this high-risk patient population.

Main Methods:

  • Analysis of the National Inpatient Sample data from 2011-2020.
  • Inclusion of patients with AF who underwent PCI with stent implantation and had increased stroke risk.
  • Investigation of demographic and clinical factors using chi-squared test, Student t-test, and multiple logistic regression.

Main Results:

  • TAT utilization increased from 30.3% in 2011 to 65.4% in 2020 (p < 0.001).
  • Positive factors for TAT use included congestive heart failure, prior stroke/TIA/thromboembolism, valvular heart disease, and the study year.
  • Negative factors included specific insurance types, medical institution type, and comorbidities like renal disease, liver disease, and prior hemorrhage history.

Conclusions:

  • TAT use in high-stroke risk AF patients undergoing PCI showed a steady increase between 2011 and 2020.
  • Despite the increase, 29.4% of patients still received only DAPT in 2020, indicating suboptimal antithrombotic management.
  • Further research and clinical practice adjustments are needed to ensure optimal antithrombotic therapy for AF patients post-PCI.
Abstract

Keywords:
Atrial fibrillationDual antithrombotic therapyPercutaneous coronary interventionTriple antithrombotic therapy

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