Antithrombotic therapies in Canadian atrial fibrillation patients with concomitant coronary artery disease: Insights from the CONNECT AFâ¯+â¯PCI-II program.
J Cardiol
; 82(2): 153-161, 2023 08.
Article
en En
| MEDLINE
| ID: mdl-36931433
ABSTRACT
BACKGROUND:
Selecting the appropriate antithrombotic regimen for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) or have had medically managed acute coronary syndrome (ACS) remains complex. This multi-centre observational study evaluated patterns of antithrombotic therapies utilized among Canadian patients with AF post-PCI or ACS. METHODS ANDRESULTS:
By retrospective chart audit, 611 non-valvular AF patients [median (interquartile range) age 76 (69-83) years, CHADS2 score 2 (1-3)] who underwent PCI or had medically managed ACS between August 2018 and December 2020 were identified by 68 cardiologists across eight provinces in Canada. Overall, triple antithrombotic therapy [TAT combined oral anticoagulation (OAC) and dual antiplatelet therapy (DAPT)] was the most common initial antithrombotic strategy, with use in 53.8â¯% of patients, followed by dual pathway therapy (32.7â¯% received OAC and a P2Y12 inhibitor, and 4.1â¯% received OAC and aspirin) and DAPT (9.3â¯%). Median duration of TAT was 30 (7, 30) days. Compared to the previous CONNECT AFâ¯+â¯PCI-I program, there was an increased use of dual pathway therapy relative to TAT over time (P-value <.0001). DOACs (direct oral anticoagulants) represented 90.3â¯% of all OACs used overall, with apixaban being the most utilized (50.5â¯%). Proton pump inhibitors were used in 57.0â¯% of all patients, and 70.1â¯% of patients on ASA. Planned antithrombotic therapies at 1â¯year were 76.2â¯% OAC monotherapy, 8.3â¯% OACâ¯+â¯ASA, 7.9â¯% OACâ¯+â¯P2Y12 inhibitor, 4.3â¯% DAPT, 1.3â¯% ASA alone, and <1â¯% triple therapy.CONCLUSION:
In accordance with recent Canadian Cardiovascular Society guideline recommendations, we observed an increased use of dual pathway therapy relative to TAT over time in both AF patients post-PCI (elective and emergent) and in those with medically managed ACS. Additionally, DOACs have become the prevailing form of anticoagulation across all antithrombotic regimens. Our findings suggest that Canadian physicians are integrating evidence-based approaches to optimally manage the bleeding and thrombotic risks of AF patients post-PCI and/or ACS.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Fibrilación Atrial
/
Enfermedad de la Arteria Coronaria
/
Intervención Coronaria Percutánea
Tipo de estudio:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
/
Humans
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Cardiol
Asunto de la revista:
CARDIOLOGIA
Año:
2023
Tipo del documento:
Article
País de afiliación:
Reino Unido