Effects of triple therapy in patients with non-valvular atrial fibrillation undergoing percutaneous coronary intervention regarding thromboembolic risk stratification

Antonia Sambola, Maria Mutuberría, Bruno García del Blanco, Albert Alonso, José A. Barrabés, Fernando Alfonso, Héctor Bueno, Angel Cequier, Javier Zueco, Oriol Rodríguez-Leor, Eduard Bosch, Pilar Tornos, David García-Dorado

Research output: Contribution to journalArticleResearchpeer-review

21 Citations (Scopus)

Abstract

© 2016, Japanese Circulation Society. All rights reserved. Background: The effects of dual antiplatelet therapy (DAPT) and triple therapy (TT: DAPT plus oral anticoagulation) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) regarding to CHA2DS2- VASc score remain undefined. We compare the effect of TT vs. DAPT in this setting regarding the CHA2DS2-VASc score. Methods and Results: In a prospective multicenter registry, 585 patients (75.2% male, 73.2±8.2 years) with AF undergoing PCI were followed up during 1 year. Of them, 157 (26.8%) had a CHA2DS2-VASc=1, and 428 (73.2%) had a CHA2DS2-VASc ≥2. TT was prescribed in 51.6% with CHA2DS2-VASc=1 and in 55.5% with CHA2DS2-VASc ≥2. Patients with CHA2DS2-VASc=1 receiving TT had a similar thromboembolism rate to those on DAPT (1.2% vs. 1.3%, P=0.73), but more total (19.5% vs. 6.9%, P=0.01) and a tendency to more major (4.9% vs. 0%, P=0.06) bleeding. However, patients with CHA2DS2-VASc ≥2 receiving TT had a lower thromboembolism rate (1.7% vs. 5.3%, P=0.03) and a trend towards more bleeds (21.8% vs. 15.6%, P=0.06), with an excess of major bleeding (8.4% vs. 3.1%, P=0.01). Rates of major adverse cardiac events (MACE) in both CHA2DS2-VASc subgroups were similar, irrespective of treatment. In a Cox multivariate analysis, TT was associated to major bleeding, but not with MACE. Conclusions: In patients with AF and CHA2DS2-VASc=1 undergoing PCI, the use of TT involves a high risk of bleeding without a significant benefit in preventing thromboembolism.
Original languageEnglish
Pages (from-to)354-362
JournalCirculation Journal
Volume80
Issue number2
DOIs
Publication statusPublished - 25 Jan 2016

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Dual antiplatelet therapy
  • Percutaneous coronary intervention
  • Thromboembolic risk

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