Key result
Following the introduction of NOACs, the use of triple antithrombotic therapy in AF patients undergoing PCI increased from 25.4% in 2013 to 46.0% in 2018, while dual antiplatelet therapy decreased from 71.9% to 49.8%.
Why the study?
Antithrombotic therapy after PCI in patients with AF has evolved with new randomized trial data and guideline updates, prompting investigation into real-world regimen trends.
Cross-Sectional (n=27,594)
The introduction of NOACs has shifted real-world antithrombotic prescription patterns in AF patients undergoing PCI toward increased use of triple antithrombotic therapy, though oral anticoagulants remain underutilized.
Answers are grounded in this paper and cite their sources.
Tracks real-world shifts in NOAC-based regimens post-PCI for AF; leaves open alignment with recent RCT-driven guidelines.
BACKGROUND AND OBJECTIVES: Antithrombotic therapy after percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF) has changed in recent years with new data from large randomized trials and updates to clinical guidelines. This study aimed to investigate the trends in periprocedural antithrombotic regimens in Korean patients with AF undergoing PCI with non-vitamin K antagonist oral anticoagulants (NOACs). METHODS: Using the claims database of the Health Insurance Review and Assessment during 2013-2018, 27,594 patients with AF undergoing PCI were identified. The annual prevalence of PCI and prescriptions of each antithrombotic agent, including antiplatelet agents and oral anticoagulants, within 30 days after PCI were investigated. RESULTS: During 2013-2018, the number of patients with AF undergoing PCI increased up to 1.3-fold (from 3,913 to 5,075 patients per year). After the introduction of NOACs, the proportion of dual antiplatelet therapy (DAPT) decreased from 71.9% to 49.8% but still occupied the largest proportion among antithrombotic regimens. Triple antithrombotic therapy (TAT) use increased from 25.4% to 46.0%, and NOAC has rapidly replaced warfarin as the oral anticoagulant of choice. TAT was preferred to DAPT for patients with CHA₂DS₂-VASc score ≥2. Among various factors, prior intracranial hemorrhage was the most powerful predictor of favoring DAPT use over TAT. CONCLUSION: Since the introduction of NOACs, the patterns of periprocedural antithrombotic regimens have changed rapidly toward more use of TAT, specifically with NOAC-based regimen. Appropriate stroke prevention with oral anticoagulants is still underutilized in patients with AF undergoing PCI in Korea.
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Kwon et al. (2021) conducted a cross-sectional in Atrial fibrillation undergoing percutaneous coronary intervention (n=27,594). Introduction of NOACs (2013-2018) vs. 2013 baseline was evaluated on Proportion of triple antithrombotic therapy (TAT) use (p=<0.001). Following the introduction of NOACs, the use of triple antithrombotic therapy in AF patients undergoing PCI increased from 25.4% in 2013 to 46.0% in 2018, while dual antiplatelet therapy decreased from 71.9% to 49.8%.
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