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Updated: Jul 9, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Experiences of Patients With Atrial Fibrillation With Combination Antithrombotic Therapy Post-Percutaneous Coronary
Caylie M Poirier1, Aleesa A Carter1,2, Yvonne Kwan1
1Pharmacy Department, University Health Network, Toronto, Ontario, Canada.
Insights
Over two-thirds of atrial fibrillation patients undergoing PCI had unplanned antithrombotic therapy modifications. These complex regimens require better patient support post-discharge to reduce risks.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Atrial fibrillation (AF) patients often have coronary artery disease requiring percutaneous coronary intervention (PCI).
- Canadian guidelines recommend complex dual or triple antithrombotic therapy (ATT) post-PCI for AF patients.
- Complex ATT regimens may lead to unplanned modifications (UPMs), increasing risks of thrombosis and bleeding.
Purpose of the Study:
- To describe the outcomes of patients with AF and PCI on combination ATT.
- To identify the frequency and types of unplanned modifications (UPMs) in ATT regimens.
- To assess the impact of UPMs on patient safety, including bleeding events.
Main Methods:
- Prospective follow-up of AF patients on oral anticoagulation (OAC) and combination ATT post-PCI.
- Patients were contacted at 1, 3, 6, and 12 months post-PCI.
- Data collection focused on UPMs to ATT and associated clinical outcomes.
Main Results:
- 68% of patients (44/61) experienced at least one UPM to their ATT.
- 105 UPMs occurred, most commonly extended P2Y12 inhibitor duration (22%) and altered acetylsalicylic acid duration (22%).
- 37% of UPMs involved OACs, and 75% of patients with UPMs experienced bleeding.
Conclusions:
- A high proportion of AF patients undergoing PCI experience UPMs to their ATT.
- The complexity of current ATT regimens presents significant challenges for both patients and clinicians.
- Enhanced post-discharge patient support is crucial for managing ATT in this population.
Background:
Up to 30% of patients with atrial fibrillation (AF) have coronary artery disease, and many undergo percutaneous coronary intervention (PCI). In the setting of acute coronary syndrome with PCI, or high-risk elective PCI, Canadian AF guidelines recommend 1-30 days of acetylsalicylic acid, 1-12 months of clopidogrel, and oral anticoagulation (OAC) with doses that may change throughout the 12 months post-PCI. The complexity of these regimens may contribute to unplanned modifications (UPMs), increasing the risk of thrombosis and/or bleeding. We describe what happens to these patients and their antithrombotic therapy (ATT) after discharge.
Methods:
Prospective follow-up was conducted of patients with AF requiring OAC who underwent PCI and were discharged on combination ATT. Patients were contacted at 1, 3, 6, and 12 months post-PCI.
Results:
Sixty-five patients were enrolled, with data at any time point available for 61 of them (94%). Of these, 44 (68%) experienced at least one UPM to ATT. In total, 105 UPMs occurred. The most common UPM was an extended duration of P2Y12 inhibitor (23 instances; 22%). The most common UPM with acetylsalicylic acid was extended (11 instances; 11%) or shortened (11 instances; 11%) duration. Thirty-nine UPMs (37%) were related to OACs; 9 (23%) were related to warfarin, and 30 (77%) were related to direct OACs. Of all patients with at least one UPM, 33 (75%) experienced bleeding.
Conclusions:
More than 2 in 3 patients with AF undergoing PCI experienced a UPM to their ATT. This study underscores the challenges of combination ATT for patients and clinicians alike, emphasizing the need for patient support after discharge.
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