AUTHOR=Heger Lukas Andreas , Danzer Martin , Bode Christoph , Hortmann Marcus , Duerschmied Daniel , Olivier Christoph B. , Moser Martin 

TITLE=Dual-Pathway Antithrombotic Therapy in Patients With Atrial Fibrillation After Percutaneous Coronary Intervention in Stable Coronary Artery Disease: A Single-Center, Single-Operator, Retrospective Cohort Study

JOURNAL=Frontiers in Medicine

VOLUME=7

YEAR=2020

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.00414

DOI=10.3389/fmed.2020.00414

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> There is limited data evaluating the prescription practices for antithrombotic therapy in patients with atrial fibrillation (AF) following elective percutaneous coronary intervention (PCI).</p><p><bold>Objective:</bold> This single-center, single-operator, retrospective cohort study aimed to evaluate trends of antithrombotic treatment strategies in patients with AF undergoing elective PCI.</p><p><bold>Methods:</bold> Patients with AF who electively underwent PCI performed by a single interventionalist between April 2013 and May 2018 were identified. The primary outcome was the antithrombotic therapy at discharge assessed by chart review: triple (TAT, triple antithrombotic therapy) or dual (DAT, dual antithrombotic therapy) antithrombotic therapy and vitamin K antagonist (VKA) or non-vitamin K antagonist oral anticoagulant (NOAC), respectively.</p><p><bold>Results:</bold> Of 6,135 screened patients, 259 met the inclusion criteria. Among these, 133 (51%) patients received NOAC- and 126 (49%) VKA-therapy. Compared with patients on NOAC therapy, patients treated with VKA had higher bleeding risk (mean HAS-BLED-Score; 2.3 vs. 2.0; <italic>p</italic> = 0.02) and more co-morbidities (estimated glomerular filtration rate &lt;30 ml/min, 11 vs. 4%; <italic>p</italic> = 0.04; diabetes mellitus, 33 vs. 20%; <italic>p</italic> = 0.03; history of previous PCI, 37 vs. 21%; <italic>p</italic> &lt; 0.01). TAT was prescribed more frequently if the prescription included VKA compared with NOAC (61 vs. 41%; <italic>p</italic> &lt; 0.01). Prescription of TAT and VKA decreased throughout the observed period (2013: 100% vs. 2018: 6%; <italic>p</italic> &lt; 0.01 and 2013: 91% vs. 2018: 28%; <italic>p</italic> &lt; 0.01).</p><p><bold>Conclusion:</bold> These observational data from a single center registry show a decrease of TAT- and VKA- prescription in favor of DAT with NOAC. Whether these observations are consistent with national or global trends should to be evaluated in further studies.</p>