Effects of Triple Therapy in Patients With Non-Valvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention Regarding Thromboembolic Risk Stratification

• Published in: Circulation Journal Vol. 80; no. 2; pp. 354 - 362
• Main Authors: Sambola, Antonia, Mutuberría, Maria, Blanco, Bruno García del, Alonso, Albert, Barrabés, José A., Alfonso, Fernando, Bueno, Héctor, Cequier, Angel, Zueco, Javier, Rodríguez-Leor, Oriol, Bosch, Eduard, Tornos, Pilar, García-Dorado, David
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2016
• Subjects: Aged; Aged, 80 and over; Anticoagulants - administration & dosage; Anticoagulation; Atrial fibrillation; Atrial Fibrillation - surgery; Dual antiplatelet therapy; Female; Humans; Male; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Platelet Aggregation Inhibitors - administration & dosage; Postoperative Hemorrhage - prevention & control; Prospective Studies; Registries; Risk Assessment; Thromboembolic risk; Thromboembolism - etiology; Thromboembolism - prevention & control
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-15-0923

Background:The effects of dual antiplatelet therapy (DAPT) and triple therapy (TT: DAPT plus oral anticoagulation) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) regarding to CHA2DS2-VASc score remain undefined.We compare the effect of TT vs. DAPT in this setting regarding the CHA2DS2-VASc score.Methods and Results:In a prospective multicenter registry, 585 patients (75.2% male, 73.2±8.2 years) with AF undergoing PCI were followed up during 1 year. Of them, 157 (26.8%) had a CHA2DS2-VASc=1, and 428 (73.2%) had a CHA2DS2-VASc ≥2. TT was prescribed in 51.6% with CHA2DS2-VASc=1 and in 55.5% with CHA2DS2-VASc ≥2. Patients with CHA2DS2-VASc=1 receiving TT had a similar thromboembolism rate to those on DAPT (1.2% vs. 1.3%, P=0.73), but more total (19.5% vs. 6.9%, P=0.01) and a tendency to more major (4.9% vs. 0%, P=0.06) bleeding. However, patients with CHA2DS2-VASc ≥2 receiving TT had a lower thromboembolism rate (1.7% vs. 5.3%, P=0.03) and a trend towards more bleeds (21.8% vs. 15.6%, P=0.06), with an excess of major bleeding (8.4% vs. 3.1%, P=0.01). Rates of major adverse cardiac events (MACE) in both CHA2DS2-VASc subgroups were similar, irrespective of treatment. In a Cox multivariate analysis, TT was associated to major bleeding, but not with MACE.Conclusions:In patients with AF and CHA2DS2-VASc=1 undergoing PCI, the use of TT involves a high risk of bleeding without a significant benefit in preventing thromboembolism. (Circ J 2016; 80: 354–362)