Evolution of Antithrombotic Management of Atrial Fibrillation After Percutaneous Coronary Intervention Over 10 Years and Guidelines Uptake

Overview

Journal CJC Open

Specialty Cardiology & Vascular Diseases

Date 2021 Sep 10

PMID 34505042

Citations 2

Authors

Marie-Claude Beaulieu

Laurie-Anne Boivin-Proulx

Alexis Matteau

Samer Mansour

Jean-Francois Gobeil

Brian J Potter

Affiliations

Soon will be listed here.

Abstract

Background: The management of atrial fibrillation and/or flutter (AF) patients requiring percutaneous coronary intervention (PCI) has evolved significantly. The Canadian Cardiovascular Society AF guidelines, last updated in 2020, seek to aid physicians in balancing both bleeding and thrombotic risks.

Methods: A tertiary academic centre registry of patients with AF who had PCI was examined for the antithrombotic therapy at discharge in 4 time periods (cohort 2010-2011; cohort 2014-2015; cohort 2017; cohort 2019). Discharge prescription patterns were compared among the cohorts, using the χ test. In addition, antithrombotic management in cohorts 2017 and 2019 were compared to guideline-expected therapy, using the χ test.

Results: A total of 576 AF patients undergoing PCI were included. Clinical and procedural characteristics were similar among cohorts, except for an increase in drug-eluting stent use in the most recent cohort (94% vs 99%; = 0.04). The rate of oral anticoagulation increased over time (75% vs 89%; < 0.01), driven primarily by an increase in direct oral anticoagulants prescription (63% vs 84%; < 0.01). In contrast to previous cohorts, there was no significant difference between the observed and the guideline-expected anticoagulation rate in cohort 2019 (89% vs 94%; = 0.23).

Conclusions: A combination of expert guidance and educational initiatives in the past decade contributed to dramatic changes in the management of patients with AF undergoing PCI.

Citing Articles

ANMCO position paper on antithrombotic treatment of patients with atrial fibrillation undergoing intracoronary stenting and/or acute coronary syndromes.

De Luca L, Rubboli A, Lettino M, Tubaro M, Leonardi S, Casella G Eur Heart J Suppl. 2022; 24(Suppl C):C254-C271.

PMID: 35663586 PMC: 9155223. DOI: 10.1093/eurheartj/suac020.

Effect of New Evidence on Antithrombotic Therapies in Atrial Fibrillation Patients Who Undergo Percutaneous Coronary Intervention in Alberta, Canada.

Eberhardt T, Bungard T, Graham M, Picard M, Wang G, Ackman M CJC Open. 2022; 4(4):378-382.

PMID: 35495861 PMC: 9039572. DOI: 10.1016/j.cjco.2021.12.007.

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