Efficacy and safety of aspirin, clopidogrel, and warfarin after coronary artery stenting in Korean patients with atrial fibrillation

• Published in: Heart and vessels Vol. 29; no. 5; pp. 578 - 583
• Main Authors: Suh, Soon Yong, Kang, Woong Chol, Oh, Pyung Chun, Choi, Hanul, Moon, Chan Il, Lee, Kyounghoon, Han, Seung Hwan, Ahn, Taehoon, Choi, In Suck, Shin, Eak Kyun
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.09.2014
• Subjects: Aged; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Asian Continental Ancestry Group; Aspirin - adverse effects; Aspirin - therapeutic use; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial Fibrillation - ethnology; Atrial Fibrillation - mortality; Biomedical Engineering and Bioengineering; Blood Coagulation - drug effects; Cardiac Surgery; Cardiology; Coronary Artery Disease - diagnosis; Coronary Artery Disease - ethnology; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronary Thrombosis - ethnology; Coronary Thrombosis - prevention & control; Disease-Free Survival; Drug Monitoring - methods; Drug Therapy, Combination; Female; Hemorrhage - chemically induced; Humans; International Normalized Ratio; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Myocardial Infarction - ethnology; Myocardial Infarction - prevention & control; Odds Ratio; Original Article; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Proportional Hazards Models; Republic of Korea; Retrospective Studies; Risk Factors; Stents; Stroke - ethnology; Stroke - prevention & control; Ticlopidine - adverse effects; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Time Factors; Treatment Outcome; Vascular Surgery; Warfarin - adverse effects; Warfarin - therapeutic use; Republic of Korea; Warfarin; Percutaneous coronary intervention; Stent; Atrial fibrillation
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-013-0399-x

There are limited data on the optimal antithrombotic therapy for patients with atrial fibrillation (AF) who undergoing coronary stenting. We reviewed 203 patients (62.6 % men, mean age 68.3 ± 10.1 years) between 2003 and 2012, and recorded clinical and demographic characteristics of the patients. Clinical follow-up included major adverse cardiac and cerebrovascular events (MACCE) (cardiac death, myocardial infarction, target lesion revascularization, and stroke), stent thrombosis, and bleeding. The most commonly associated comorbidities were hypertension (70.4 %), diabetes mellitus (35.5 %), and congestive heart failure (26.6 %). Sixty-three percent of patients had stroke risk higher than CHADS 2 score 2. At discharge, dual-antiplatelet therapy (aspirin, clopidogrel) was used in 166 patients (81.8 %; Group I), whereas 37 patients (18.2 %) were discharged with triple therapy (aspirin, clopidogrel, warfarin; Group II). The mean follow-up period was 42.0 ± 29.0 months. The mean international normalized ratio (INR) in group II was 1.83 ± 0.41. The total MACCE was 16.3 %, with stroke in 3.4 %. Compared with the group II, the incidence of MACCE (2.7 % vs 19.3 %, P = 0.012) and cardiac death (0 % vs 11.4 %, P = 0.028) were higher in the group I. Major and any bleeding, however, did not differ between the two groups. In multivariate analysis, no warfarin therapy (odds ratio 7.8, 95 % confidence interval 1.02–59.35; P = 0.048) was an independent predictor of MACCE. By Kaplan–Meier survival analysis, warfarin therapy was associated with a lower risk of MACCE ( P = 0.024). In patients with AF undergoing coronary artery stenting, MACCE were reduced by warfarin therapy without increased bleeding, which might be related to tighter control with a lower INR value.