Key result
In patients with atrial fibrillation and a CHA2DS2-VASc score of 1 undergoing PCI, triple therapy did not significantly reduce thromboembolism compared to dual antiplatelet therapy (1.2% vs 1.3%) but was associated with a higher risk of bleeding.
Why the study?
Does triple therapy compared to dual antiplatelet therapy reduce thromboembolism or increase bleeding in patients with non-valvular atrial fibrillation undergoing PCI?
Cohort (n=585)
Yes
Does triple therapy compared to dual antiplatelet therapy reduce thromboembolism or increase bleeding in patients with non-valvular atrial fibrillation undergoing PCI?
Absolute Event Rate: 1.2% vs 1.3%
p-value: p=0.73
In AF patients undergoing PCI with a CHA2DS2-VASc score of 1, triple therapy increases bleeding without reducing thromboembolism compared to DAPT, whereas it reduces thromboembolism at the cost of increased major bleeding in those with a score ≥2.
BACKGROUND: The effects of dual antiplatelet therapy (DAPT) and triple therapy (TT: DAPT plus oral anticoagulation) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) regarding to CHA2DS2-VASc score remain undefined.We compare the effect of TT vs. DAPT in this setting regarding the CHA2DS2-VASc score. METHODS AND RESULTS: In a prospective multicenter registry, 585 patients (75.2% male, 73.2 ± 8.2 years) with AF undergoing PCI were followed up during 1 year. Of them, 157 (26.8%) had a CHA2DS2-VASc=1, and 428 (73.2%) had a CHA2DS2-VASc ≥2. TT was prescribed in 51.6% with CHA2DS2-VASc=1 and in 55.5% with CHA2DS2-VASc ≥ 2. Patients with CHA2DS2-VASc=1 receiving TT had a similar thromboembolism rate to those on DAPT (1.2% vs. 1.3%, P=0.73), but more total (19.5% vs. 6.9%, P=0.01) and a tendency to more major (4.9% vs. 0%, P=0.06) bleeding. However, patients with CHA2DS2-VASc ≥ 2 receiving TT had a lower thromboembolism rate (1.7% vs. 5.3%, P=0.03) and a trend towards more bleeds (21.8% vs. 15.6%, P=0.06), with an excess of major bleeding (8.4% vs. 3.1%, P=0.01). Rates of major adverse cardiac events (MACE) in both CHA2DS2-VASc subgroups were similar, irrespective of treatment. In a Cox multivariate analysis, TT was associated to major bleeding, but not with MACE. CONCLUSIONS: In patients with AF and CHA2DS2-VASc=1 undergoing PCI, the use of TT involves a high risk of bleeding without a significant benefit in preventing thromboembolism.
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Sambola et al. (2015) conducted a cohort in Non-valvular atrial fibrillation undergoing percutaneous coronary intervention (n=585). Triple therapy (oral anticoagulation plus dual antiplatelet therapy) vs. Dual antiplatelet therapy (DAPT) was evaluated on Any thromboembolic event (stroke or peripheral embolism) in the CHA2DS2-VASc=1 subgroup (p=0.73). In patients with atrial fibrillation and a CHA2DS2-VASc score of 1 undergoing PCI, triple therapy did not significantly reduce thromboembolism compared to dual antiplatelet therapy (1.2% vs 1.3%) but was associated with a higher risk of bleeding.
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