How cardiologists manage antithrombotic treatment of patients with atrial fibrillation undergoing percutaneous coronary
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Neth Heart J https://doi.org/10.1007/s12471-020-01500-3
How cardiologists manage antithrombotic treatment of patients with atrial fibrillation undergoing percutaneous coronary stenting: the WOEST survey 2018 A. J. W. M. de Veer · N. Bennaghmouch · W. J. M. Dewilde · J. M. ten Berg
Accepted: 30 September 2020 © The Author(s) 2020
Abstract Background Antithrombotic treatment choices are complicated when patients have both atrial fibrillation (AF) and acute coronary syndrome and/or undergo percutaneous coronary intervention (PCI). In this study, we aimed to gain insight into antithrombotic management strategies in daily clinical practice. Methods We invited interventional cardiologists to complete the WOEST (What is the Optimal antiplatElet & Anticoagulant Therapy in Patients With Oral Anticoagulation and Coronary StenTing) survey 2018. In this questionnaire, we presented a patient with a non-ST-elevation myocardial infarction (NSTEMI) and an elective PCI case. Results The results were based on 118 completed questionnaires (response rate 69.4%). In the case of the AF patient with NSTEMI, most cardiologists indicated they would initiate dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) and continue non-vitamin K antagonist oral anticoagulant (NOAC) therapy at admission and during coronary angiography/PCI. At discharge, 70.3% would prescribe triple antithrombotic therapy (oral anticoagulation, acetylsalicylic acid and clopidogrel), mostly for 1 month. One year after NSTEMI, 83.1% would cancel the antiplatelet therapy and prescribe NOAC monotherapy. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12471-020-01500-3) contains supplementary material, which is available to authorized users. A. J. W. M. de Veer () · N. Bennaghmouch · J. M. ten Berg Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands [email protected] W. J. M. Dewilde Department of Cardiology, Imelda Hospital, Bonheiden, Belgium
For the AF patient undergoing elective PCI, 51.7% would start dual antiplatelet therapy prior to the procedure and 52.5% would discontinue NOAC therapy prior to the PCI. At discharge, 55.1% would start triple antithrombotic therapy. Furthermore, 25.4% responded they routinely prescribe a reduced dose of NOAC after discharge. One year after PCI, 89.0% would continue NOAC monotherapy. Conclusion The WOEST survey demonstrated heterogeneity in antithrombotic management strategies among interventional cardiologists. This observed variety mirrors the heterogeneity of the many guidelines and consensus documents. Further research is needed to guide patient-tailored medicine for AF patients undergoing PCI. Keywords Anticoagulation · Antiplatelet therapy · Acute coronary syndrome · Percutaneous coronary intervention · Atrial fibrillation · Non-vitamin K antagonist oral anticoagulants What’s new?
To investigate antithrombotic management strategies for atrial fibrillation (AF) patients treated with oral anticoagulation undergoing percutaneous
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