Related Experiment Video
Updated: Aug 6, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Antithrombotic Therapy in Patients With Atrial Fibrillation With Prior Complex PCI: A Secondary Analysis of the
Hong-Ki Jeon1, Ho Sung Jeon2, Kyounghoon Lee3
1Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (H.-K.J., S.-H.L., Y.-J.L., S.-J.L., H.T.Y., S.-J.H., C.-M.A., B.-K.K., Y.-G.K., D.C., M.-K.H., Y.J., H.-N.P., J.-S.K.).
Insights
Non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy significantly reduced net adverse clinical events and bleeding in patients with atrial fibrillation after percutaneous coronary intervention (PCI), regardless of PCI complexity. Ischemic outcomes were similar between NOAC monotherapy and combination therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Atrial fibrillation and chronic coronary syndrome patients require long-term anticoagulation post-PCI.
- Guidelines recommend oral anticoagulant monotherapy beyond 12 months.
- Efficacy and safety of monotherapy in complex PCI remain uncertain.
Purpose of the Study:
- To evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy versus NOAC plus clopidogrel in patients with atrial fibrillation after drug-eluting stent implantation.
- To assess outcomes based on percutaneous coronary intervention (PCI) complexity.
Main Methods:
- Post hoc analysis of the ADAPT AF-DES randomized trial.
- Included patients with atrial fibrillation ≥12 months after second- or third-generation drug-eluting stent implantation.
- Complex PCI defined by specific criteria (e.g., ≥3 stents, ≥3 lesions, total stent length ≥60 mm).
Main Results:
- NOAC monotherapy reduced net adverse clinical events in both complex (HR 0.42) and noncomplex PCI groups (HR 0.59).
- Ischemic outcomes were infrequent and did not differ significantly between strategies.
- Bleeding outcomes were consistently lower with NOAC monotherapy regardless of PCI complexity.
Conclusions:
- NOAC monotherapy significantly reduces bleeding and net adverse clinical events post-PCI in atrial fibrillation patients, irrespective of PCI complexity.
- A bleeding-focused antithrombotic strategy may be suitable for patients with prior complex PCI.
- Prospective validation is warranted.
Background:
In patients with atrial fibrillation and chronic coronary syndrome beyond 12 months after percutaneous coronary intervention (PCI), oral anticoagulant monotherapy is recommended by the guideline; however, its efficacy and safety in patients with complex PCI remain uncertain.
Methods:
We conducted a post hoc analysis of the randomized ADAPT AF-DES trial (Appropriate Duration of Antiplatelet and Thrombotic Strategy After 12 Months in Patients With Atrial Fibrillation Treated With Drug-Eluting Stents), which compared non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy with NOAC plus clopidogrel in patients with atrial fibrillation ≥12 months after second- or third-generation drug-eluting stent implantation. Complex PCI was defined by one of the following characteristics: ≥3 stents, ≥3 lesions, bifurcation with 2 stents, total stent length ≥60 mm, left main PCI, or chronic total occlusion PCI. Net adverse clinical events, ischemic composite outcomes, and bleeding composite outcomes were evaluated according to PCI complexity.
Results:
Among 960 patients, 247 (25.7%) underwent complex PCI and 713 (74.3%) underwent noncomplex PCI. NOAC monotherapy was associated with a lower risk of net adverse clinical events compared with combination therapy in both the complex PCI group (9.5% versus 21.5%; hazard ratio, 0.42 [95% CI, 0.21-0.83]; P=0.01) and the noncomplex PCI group (9.6% versus 15.7%; hazard ratio, 0.59 [95% CI, 0.39-0.90]; P=0.02), with no significant interaction. Ischemic outcomes were infrequent and did not differ significantly between treatment strategies regardless of PCI complexity, whereas bleeding outcomes were consistently lower with NOAC monotherapy in both complex and noncomplex PCI groups.
Conclusions:
In this post hoc analysis of the randomized ADAPT AF-DES trial, NOAC monotherapy beyond 12 months after PCI was associated with a substantial reduction in bleeding regardless of PCI complexity. Although limited by low absolute event rates, ischemic outcomes did not differ significantly between treatment strategies. These findings suggest that a bleeding-focused long-term antithrombotic strategy may be reasonable in patients with atrial fibrillation and chronic coronary syndrome, including those with prior complex PCI, although prospective validation remains warranted.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04250116.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:29Venous Thrombosis III: 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...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:26Atherosclerosis III: Management