Trends of Antithrombotic Treatment in Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention: Insigh
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ORIGINAL ARTICLE
Trends of Antithrombotic Treatment in Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention: Insights from the GReek-AntiPlatElet Atrial Fibrillation (GRAPE-AF) Registry Despoina-Rafailia Benetou 1 & Charalampos Varlamos 1 & Dionysios Ktenas 2 & Ioannis Tsiafoutis 3 & Michael Koutouzis 3 & Theodora Bampali 4 & Christos Mantis 5 & John Zarifis 6 & Emmanouil Skalidis 7 & Dionysios Aravantinos 8 & Dimitrios Varvarousis 9 & Ioannis Lianos 1 & John Kanakakis 10 & Evangelos Pisimisis 11 & Antonios Ziakas 12 & Periklis Davlouros 2 & Dimitrios Alexopoulos 1 & on behalf of GRAPE-AF investigators Accepted: 1 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) are a high-risk subset of patients, whose optimal antithrombotic treatment strategy, involving a combination of anticoagulant and antiplatelet agents, has not been well defined. Our study aims to investigate contemporary “real-world” trends of antithrombotic treatment strategies in AF patients undergoing PCI, as well as identify factors affecting decision-making at hospital discharge. Methods “Real-world” data were retrieved from the GReek-AntiPlatElet Atrial Fibrillation (GRAPE-AF) registry, a contemporary, nationwide, multicenter, observational study of AF patients undergoing PCI. Characteristics of patients discharged on triple antithrombotic therapy (TAT) or dual antithrombotic therapy (DAT) were compared in order to identify factors that could influence treatment decisions. Results A total of 654 patients were enrolled (42% with stable coronary artery disease, 58% with acute coronary syndrome). TAT was adopted in 49.9% and DAT in 49.2% of patients at discharge. Regarding anticoagulants, the vast majority of patients (92.9%) received non-vitamin K antagonist oral anticoagulants (NOACs) and only 7.1% received vitamin K antagonists (VKAs). Dyslipidemia, insulin-dependent diabetes mellitus, prior myocardial infarction, acute coronary syndrome at presentation, and regional variations were predictive of TAT adoption, whereas the use of NOACs or ticagrelor was predictive of DAT adoption. Conclusion Contemporary “real-world” data concerning antithrombotic treatment in AF patients undergoing PCI indicate a strong shift towards the use of NOACs instead of VKAs, along with a large subset of patients adopting an aspirin-free strategy early after index PCI, with clinical as well as treatment characteristics affecting decision-making. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10557-020-07090-x) contains supplementary material, which is available to authorized users. * Dimitrios Alexopoulos [email protected] 1
2
2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Rimini 1, Chaidari, 12462 Athens, Greece Cardiology Department, Patras University Hospital, Patras, Greece
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Cardiology
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