Comparison of early clinical outcomes between dual antiplatelet therapy and triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention



Park, Jiesuck, Jung, Jin-Hyung, Choi, Eue-Keun, Lee, Seung-Woo, Kwon, Soonil, Lee, So-Ryoung, Kang, Jeehoon, Han, Kyung-Do, Park, Kyung Woo, Oh, Seil
et al (show 1 more authors) (2022) Comparison of early clinical outcomes between dual antiplatelet therapy and triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention. PLOS ONE, 17 (2). e0264538-.

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Abstract

<h4>Background and objective</h4>Most Asian patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) receive only dual antiplatelet therapy (DAPT) without oral anticoagulants (vitamin K antagonists [VKA] or non-VKA oral anticoagulants [NOAC]). However, it has not been fully investigated whether the DAPT results in better clinical outcomes in the early period after PCI than the standard triple therapy with VKA or NOAC.<h4>Methods</h4>We analyzed the claims records of 11,039 Korean AF population who had PCI between 2013 and 2018. Patients were categorized according to the post-PCI antithrombotic therapy as VKA-based triple therapy (VKA-TT), NOAC-based triple therapy (NOAC-TT), and DAPT groups. After baseline adjustment using inverse probability weighting, we compared the risks of ischemic endpoints (ischemic stroke, myocardial infarction, and all-cause mortality) and major bleeding at 3 months post-PCI.<h4>Results</h4>Ischemic stroke, MI, and all-cause mortality occurred in 105, 423, and 379 patients, respectively, and 138 patients experienced major bleeding. The DAPT group was associated with a lower risk of ischemic stroke and major bleeding (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.37-0.84) compared to the VKA-TT group, despite no significant differences in the risks of MI and all-cause mortality. In contrast, the DAPT group demonstrated no significant difference in the risks for ischemic endpoints compared to the NOAC-TT group. Additionally, the DAPT group had a numerically lower risk of major bleeding than the NOAC-TT group but this was not statistically significant (HR 0.69, 95% CI 0.45-1.07).<h4>Conclusions</h4>An outcome benefit of DAPT was observed in the early period after PCI compared to the VKA-TT, but not against NOAC-TT users among the Asian AF population. Given the potential long-term benefits of NOACs, greater efforts should be made to increase compliance in clinical practice with proper combination therapy with NOAC after PCI.

Item Type: Article
Uncontrolled Keywords: Humans, Atrial Fibrillation, Myocardial Infarction, Hemorrhage, Fibrinolytic Agents, Platelet Aggregation Inhibitors, Treatment Outcome, Drug Therapy, Combination, Administration, Oral, Proportional Hazards Models, Risk Factors, Databases, Factual, Aged, Female, Male, Kaplan-Meier Estimate, Percutaneous Coronary Intervention, Dual Anti-Platelet Therapy, Ischemic Stroke
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 06 May 2022 15:17
Last Modified: 18 Jan 2023 21:04
DOI: 10.1371/journal.pone.0264538
Open Access URL: https://journals.plos.org/plosone/article?id=10.13...
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3154390