Effects of Triple Therapy in Patients With Non-Valvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention Regarding Thromboembolic Risk Stratification
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 CHA(2)DS(2)-VASc score remain undefined. We compare the effect of TT vs. DAPT...
| Autores: | , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2016 |
| País: | España |
| Institución: | Institut d'Investigació i Innovació Parc Taulí (I3PT) |
| Repositorio: | r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí |
| OAI Identifier: | oai:i3pt.fundanetsuite.com:p5876 |
| Acceso en línea: | https://i3pt.portalinvestigacion.com/publicaciones/5876 |
| Access Level: | acceso abierto |
| Palabra clave: | Anticoagulation Atrial fibrillation Dual antiplatelet therapy Percutaneous coronary intervention Thromboembolic risk |
| Sumario: | 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 CHA(2)DS(2)-VASc score remain undefined. We compare the effect of TT vs. DAPT in this setting regarding the CHA(2)DS(2)-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 CHA(2)DS(2)-VASc=1, and 428 (73.2%) had a CHA(2)DS(2)-VASc >= 2. TT was prescribed in 51.6% with CHA(2)DS(2)-VASc=1 and in 55.5% with CHA(2)DS(2)-VASc >= 2. Patients with CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-VASc=1 undergoing PCI, the use of TT involves a high risk of bleeding without a significant benefit in preventing thromboembolism. |
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