Open AccessTime trends in antithrombotic management of patients with atrial fibrillation treated with coronary stents: Results from TALENT‐AF (The internAtionaL stENT – Atrial Fibrillation study) multicenter registry
Author(s) -
Potter Brian J.,
Andò Giuseppe,
Cimmino Giovanni,
LadeirasLopes Ricardo,
Frikah Zied,
Chen Xin Yue,
Virga Vittorio,
GoncalvesAlmeida Joao,
Camm A. John,
Fox Keith A.A.
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22898
Subject(s) - medicine , atrial fibrillation , conventional pci , antithrombotic , percutaneous coronary intervention , cohort , medical prescription , cardiology , retrospective cohort study , odds ratio , cohort study , myocardial infarction , pharmacology
Background Antithrombotic management of patients with atrial fibrillation (AF) requiring percutaneous coronary intervention (PCI) is highly variable; limited evidence‐based guidelines exist to influence practice. Hypothesis Patient characteristics and availability of novel drugs may have contributed to practice variability. Methods We undertook an international multicenter retrospective registry of AF patients treated with PCI. The primary measures of interest were antiplatelet and OAC prescriptions at discharge. We compared temporal trends between Prior (2010–2012) and Recent (2013–2015) cohorts and investigated variables associated with OAC prescription. Results We identified 488 cases (140 Prior, 348 Recent). Median CHADS 2 and HAS‐BLED scores were 2 (IQR, 1–3) and 2 (IQR, 2–3). Clinical characteristics were similar between cohorts, with high (85%) prevalence of ACS. More patients in the Recent cohort, compared with Prior, received OAC (56.9% vs 44.3%; P = 0.01) and NOAC (27.3% vs 3.6%; P < 0.01) at baseline. Triple therapy at discharge was not different between the cohorts. Clinical presentation with ACS and consequent use of potent P2Y 12 inhibitors were associated with reduced odds of OAC prescription at discharge (OR: 0.57, P = 0.045 and OR: 0.38, P = 0.023, respectively). Conclusions Despite little change over time in clinical characteristics of AF patients undergoing PCI, significantly more patients received OAC at presentation. However, triple therapy was not more frequent in the Recent cohort, and ACS presentation was associated with lack of OAC at discharge. We underscore the need for trial evidence and use of updated guidelines to assist clinicians in balancing ischemic and bleeding risks.