
Could the PARIS Risk Scores Be Useful for the Choice of Triple versus Dual Antithrombotic Therapy in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention?
Author(s) -
Leonardo De Luca,
Leonardo Bolognese,
Andrea Rubboli,
Donata Lucci,
Domenico Gabrielli,
Furio Colivicchi,
Michele Massimo Gulizia
Publication year - 2022
Publication title -
cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.547
H-Index - 63
eISSN - 1421-9751
pISSN - 0008-6312
DOI - 10.1159/000521673
Subject(s) - antithrombotic , medicine , conventional pci , percutaneous coronary intervention , atrial fibrillation , cardiology , observational study , myocardial infarction
Current guidelines recommend dual antithrombotic therapy (DAT) for the majority of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) and suggest a short course of triple antithrombotic therapy (TAT) for those at very high thrombotic risk (TR) but low bleeding risk (BR). Methods: We analyze if the PARIS ischemic-hemorrhagic scale could be useful for the choice of antithrombotic strategy in patients with acute coronary syndromes and AF treated with coronary stenting enrolled in the prospective, observational, nationwide MATADOR-PCI study. Results: Among the 588 patients discharged alive, a TAT was prescribed in 381 (64.8%) and DAT in 52 (8.8%) patients. According to the PARIS scoring system, 142 (24.2%) were classified as low, 244 (41.5%) as intermediate, and 292 (34.3%) as high TR. In parallel, 87 (14.8%) were categorized in the low, 260 (44.2%) in the intermediate, and 241 (41.0%) in the high-risk stratum for major bleedings. Crossing the various strata of the two PARIS risk scores, the largest group of patients consisted of those at high TR and BR ( n = 130, 22%), followed by those at intermediate risk according to both scores ( n = 122, 21%). At discharge, TAT was mainly used in patients at intermediate to high BR, while DAT in those at intermediate to high TR but low BR, according to the PARIS score. Conclusion: Our data suggest that some variables associated with increased TR or BR are poorly considered in the daily practice, while the use of PARIS scales could help in the implementation of guidelines’ recommendations.