Comparison of different antithrombotic regimens for patients with atrial fibrillation undergoing drug-eluting stent implantation.

Abstract

BACKGROUND:

The optimal antithrombotic strategy for patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation is unknown.

METHODS AND RESULTS:

The 622 consecutive AF patients undergoing DES implantation were prospectively enrolled. Among them, 142 patients (TT group) continued triple antithrombotic therapy comprising aspirin, clopidogrel and warfarin after discharge; 355 patients (DT group) had dual antiplatelet therapy; 125 patients (WS group) were discharged with warfarin and a single antiplatelet agent. Target INR was set as 1.8-2.5 and was regularly monitored after discharge. The TT group had a significant reduction in stroke and major adverse cardiac and cerebral events (MACCE) (8.8% vs 20.1% vs 14.9%, P=0.010) as compared with either the DT or WS group. In the Cox regression analysis, administration with warfarin (hazard ratio (HR) 0.49; 95% confidence interval (CI) 0.31-0.77; P=0.002) and baseline CHADS(2) score >or=2 (HR 2.09; 95%CI 1.27-3.45; P=0.004) were independent predictors of MACCE. Importantly, the incidence of major bleeding was comparable among 3 groups (2.9% vs 1.8% vs 2.5%, P=0.725), although the overall bleeding rate was increased in the TT group. Kaplan-Meier analysis indicated that the TT group was associated with the best net clinical outcome.

CONCLUSIONS:

The cardiovascular benefits of triple antithrombotic therapy were confirmed by reducing the MACCE rate, and its major bleeding risk might be acceptable if the INR is closely monitored.

• Authors: Fei Gao, Yu Jie Zhou, Zhi Jian Wang, Hua Shen, Xiao Li Liu, Bin Nie, Zhen Xian Yan, Shi Wei Yang, De An Jia, Miao Yu
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 74 Issue 4 Pg. 701-8 (Apr 2010) ISSN: 1347-4820 [Electronic] Japan
• PMID: 20208381 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Fibrinolytic Agents
• Warfarin
• Clopidogrel
• Ticlopidine
• Aspirin

Topics

• Aged
• Angioplasty, Balloon, Coronary
• Aspirin (adverse effects, therapeutic use)
• Atrial Fibrillation (complications)
• Clopidogrel
• Coronary Artery Disease (therapy)
• Drug Therapy, Combination
• Drug-Eluting Stents
• Female
• Fibrinolytic Agents (adverse effects, therapeutic use)
• Follow-Up Studies
• Hemorrhage (epidemiology)
• Humans
• Kaplan-Meier Estimate
• Male
• Prospective Studies
• Risk Factors
• Stroke (epidemiology, prevention & control)
• Thromboembolism (epidemiology, prevention & control)
• Ticlopidine (adverse effects, analogs & derivatives, therapeutic use)
• Treatment Outcome
• Warfarin (adverse effects, therapeutic use)