What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation undergoing percutaneous coronary intervention (n=28280). Intervention: Calendar year (2006 to 2015) vs. 2006 (baseline year). Primary outcome: Prescription rate of triple therapy (oral anticoagulant plus dual antiplatelet) (p=<0.001).

January 15, 2019PLoS ONEOpen Access

Temporal trends in prevalence and antithrombotic treatment among Asians with atrial fibrillation undergoing percutaneous coronary intervention: A nationwide Korean population-based study

Q: What are the key findings of this study?

From 2006 to 2015, the prescription rate of triple therapy among patients with atrial fibrillation undergoing percutaneous coronary intervention increased significantly from 22.7% to 38.3% (ptrend <0.001).

View Full Paper

Ask AI

Bookmark

Key result

From 2006 to 2015, the prescription rate of triple therapy among patients with atrial fibrillation undergoing percutaneous coronary intervention increased significantly from 22.7% to 38.3% (ptrend <0.001).

Why the study?

Recent 10-year trends in the number of patients with AF undergoing PCI and their antithrombotic therapy prescription patterns needed investigation.

Study Design

Type

Observational (n=28,280)

Structured PICO

Population

28,280 Korean adults with non-valvular atrial fibrillation undergoing percutaneous coronary intervention between 2006 and 2015, assessed for temporal trends in antithrombotic therapy.

Exposure

Antithrombotic therapy after PCI (antiplatelets and oral anticoagulants, including vitamin K antagonists and non-vitamin K antagonist oral anticoagulants [NOACs])

Outcome

Annual prevalence of PCI and patterns of antithrombotic therapy after PCI

Main Result

Absolute Event Rate: 38.3% vs 22.7%

p-value: p=<0.001

There has been a gradual increase in the use of triple antithrombotic therapy, particularly NOAC-based regimens, among AF patients undergoing PCI in Korea from 2006 to 2015, though underuse remains common in certain high-risk subgroups.

Limitations

Information about individual patients' drug compliance was not available.
Clinical information about contraindications to OACs use based on the assessment of bleeding risk was not available.
Laboratory data including time in therapeutic range in patients using VKAs were not available.
The study included prescription records only until 2015, so trends from 2016 onwards cannot be presented.
Long-term clinical efficacy and safety outcomes according to different antithrombotic therapy regimens were not evaluated.

Implication

Rising triple therapy use in AF-PCI patients warrants bleeding surveillance; leaves optimal regimens and net benefit open in observational cohorts.

Abstract

BACKGROUND: We investigated the recent 10-year trends in the number of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) in relation to prescription patterns of antithrombotic therapy. METHODS: We analyzed the annual prevalence of PCI and patterns of antithrombotic therapy after PCI, including antiplatelets and oral anticoagulants (vitamin K antagonists and non-vitamin K antagonist oral anticoagulants [NOACs]), in patients with AF between 2006 and 2015 by using the Korean National Health Insurance Service database. Independent factors associated with triple therapy (oral anticoagulant plus dual antiplatelet) prescription were assessed using multivariable logistic regression analysis. RESULTS: The number of patients with AF undergoing PCI increased gradually from 2006 (n = 2,140) to 2015 (n = 3,631) (ptrend<0.001). In 2006, only 22.7% of patients received triple therapy after PCI although 96.2% of them were indicated for anticoagulation (CHA2DS2-VASc score ≥2). The prescription rate of triple therapy increased to 38.3% in 2015 (ptrend<0.001), which was mainly attributed to a recent increment of NOAC-based triple therapy from 2013 (17.5% in 2015). Previous ischemic stroke or systemic embolism, old age, hypertension, and congestive heart failure were significantly associated with a higher triple therapy prescription rate, whereas previous myocardial infarction, PCI, and peripheral arterial disease were associated with triple therapy underuse. CONCLUSIONS: From 2006 to 2015, the number of patients with AF undergoing PCI and the prescription rate of triple therapy increased gradually with a recent increment of NOAC-based antithrombotic therapy from 2013. Previous myocardial infarction, peripheral artery disease, and PCI were associated with underuse of triple therapy.

Discussion

No takes yet. Share an insight, caveat, or question.

Figures from the paper

Published by PLoS ONE · CC BY

Cite This Study

Park et al. (2019) conducted an observational in Atrial fibrillation undergoing percutaneous coronary intervention (n=28,280). Calendar year (2006 to 2015) vs. 2006 (baseline year) was evaluated on Prescription rate of triple therapy (oral anticoagulant plus dual antiplatelet) (p=<0.001). From 2006 to 2015, the prescription rate of triple therapy among patients with atrial fibrillation undergoing percutaneous coronary intervention increased significantly from 22.7% to 38.3% (ptrend <0.001).

synapsesocial.com/papers/6a5d67919d99f8a47ce1f972 https://doi.org/10.1371/journal.pone.0209593