Key result
Less than half (49.8%) of patients with atrial fibrillation and an indication for oral anticoagulation were prescribed it following percutaneous coronary intervention, with younger patients (<65 years) more likely to receive it than older patients (69% vs 41%, p<0.01).
Why the study?
Managing oral anticoagulation in patients with AF undergoing PCI presents a dilemma due to concurrent indications for dual antiplatelet therapy, prompting an evaluation of anticoagulation patterns and risk factors influencing prescribing habits.
What are the anticoagulation prescribing patterns and associated risk factors in patients with atrial fibrillation following percutaneous coronary intervention?
Observational (n=211)
Yes
What are the anticoagulation prescribing patterns and associated risk factors in patients with atrial fibrillation following percutaneous coronary intervention?
Less than half of AF patients undergoing PCI with an indication for OAC are prescribed it at discharge, with older patients paradoxically less likely to receive OAC despite having a higher stroke risk.
A common dilemma facing physicians treating patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) is the management of oral anticoagulation (OAC) therapy, because there is also an indication for dual antiplatelet therapy in these patients. The purpose of this study was therefore to evaluate anticoagulation patterns in this patient population in an attempt to identify patterns of risk factors that may influence OAC prescribing habits. This retrospective study entailed a review of a total of 4,648 patients from two academic hospitals who underwent PCI between 2008 and 2016. We ultimately included 211 patients who had AF and an indication for OAC. Chart review revealed patients' risk factors, CHA 2 DS 2 -VASc and HAS-BLED scores, and antithrombotic regimens. Only 105 (49.8%) patients who met the indications for OAC were actually placed on OAC post-PCI. There was no significant relationship between discharge on OAC and HAS-BLED score (t = 0.14; p = 0.44) or CHA 2 DS 2 -VASc score (t = 0.76; p = 0.22). Patients younger than 65 years of age were prescribed more triple therapy (56% versus 33%; p < 0.01) or any OAC (69% versus 41%; p < 0.01) on discharge in comparison with patients 65 years of age or older. The older patient group had a significantly higher average CHA 2 DS 2 -VASc score (4.4 versus 3.2; p < 0.01) and a higher average HAS-BLED score (2.8 versus 2.4; p < 0.01). Ultimately, this study indicated that less than half of AF patients with an indication for OAC were placed on OAC post-PCI. There was no association between discharge on OAC and CHA 2 DS 2 -VASc score, HAS-BLED score, or any other individual risk factor, with the exception of age.
No takes yet. Share an insight, caveat, or question.
Rusia et al. (2019) conducted an observational in Atrial fibrillation following percutaneous coronary intervention (n=211). Oral anticoagulation prescription vs. No oral anticoagulation was evaluated on Prescription of oral anticoagulation at discharge. Less than half (49.8%) of patients with atrial fibrillation and an indication for oral anticoagulation were prescribed it following percutaneous coronary intervention, with younger patients (<65 years) more likely to receive it than older patients (69% vs 41%, p<0.01).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: