Dual antithrombotic therapy with oral anticoagulant and P2Y12 inhibitors in patients with atrial fibrillation after percutaneous coronary intervention.
J Cardiol
; 82(3): 207-214, 2023 09.
Article
en En
| MEDLINE
| ID: mdl-37336423
ABSTRACT
BACKGROUND:
The efficacy and safety of dual antithrombotic therapy (DAT) with oral anticoagulant and P2Y12 inhibitors (P2Y12i) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) have not been well investigated. The purpose of this study was first to evaluate clinical outcomes of DAT with P2Y12i compared with triple antithrombotic therapy (TAT), and then to compare DAT with low-dose prasugrel and DAT with clopidogrel, in patients with AF undergoing PCI.METHODS:
This study was a multicenter, non-interventional, prospective and retrospective registry. A total of 710 patients with AF undergoing PCI between January 2015 and March 2021 at 15 institutions were analyzed. Clinical outcomes within 1â¯year, including major adverse cardiovascular events (MACE) and major bleeding events (BARC 3 or 5) were compared between patients receiving DAT (nâ¯=â¯239) and TAT (nâ¯=â¯471), and then, compared among prasugrel-DAT (nâ¯=â¯82), clopidogrel-DAT (nâ¯=â¯157), and TAT.RESULTS:
The DAT group showed significantly lower incidence of MACE and major bleeding events compared with the TAT group (log-rank pâ¯=â¯0.013 and 0.047). In the multivariable Cox regression analyses, DAT (pâ¯=â¯0.028), acute coronary syndrome (pâ¯=â¯0.025), and anemia (pâ¯=â¯0.015) were independently associated with MACE. In addition, anemia (pâ¯=â¯0.022) was independently associated with, and DAT (pâ¯=â¯0.056) and thrombocytopenia (pâ¯=â¯0.051) tended to be associated with, major bleeding events. When analyzed among the prasugrel-DAT, clopidogrel-DAT, and TAT groups, there were no significant differences in clinical outcomes between the prasugrel-DAT and clopidogrel-DAT groups, and similar trends were observed for both 2 groups in comparison with the TAT group.CONCLUSIONS:
In AF patients undergoing PCI, DAT was associated with lower incidence of MACE and major bleeding events compared with TAT. In comparison of P2Y12i, there might be no significant difference in the incidence of MACE and bleeding events between prasugrel-based DAT and clopidogrel-based DAT.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Fibrilación Atrial
/
Intervención Coronaria Percutánea
Tipo de estudio:
Clinical_trials
/
Observational_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Año:
2023
Tipo del documento:
Article