TY - JOUR
T1 - Effects of triple therapy in patients with non-valvular atrial fibrillation undergoing percutaneous coronary intervention regarding thromboembolic risk stratification
AU - Sambola, Antonia
AU - Mutuberría, Maria
AU - del Blanco, Bruno García
AU - Alonso, Albert
AU - Barrabés, José A.
AU - Alfonso, Fernando
AU - Bueno, Héctor
AU - Cequier, Angel
AU - Zueco, Javier
AU - Rodríguez-Leor, Oriol
AU - Bosch, Eduard
AU - Tornos, Pilar
AU - García-Dorado, David
PY - 2016/1/25
Y1 - 2016/1/25
N2 - © 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.
AB - © 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.
KW - Anticoagulation
KW - Atrial fibrillation
KW - Dual antiplatelet therapy
KW - Percutaneous coronary intervention
KW - Thromboembolic risk
U2 - 10.1253/circj.CJ-15-0923
DO - 10.1253/circj.CJ-15-0923
M3 - Article
VL - 80
SP - 354
EP - 362
JO - Circulation Journal
JF - Circulation Journal
SN - 1346-9843
IS - 2
ER -