Management of Antithrombotic Therapy in Patients With Coexisting Atrial Fibrillation and Coronary Artery Disease Who Underwent Percutaneous Coronary Intervention Within the Last Year

Sebastian König; Sven Hohenstein; Johannes Leiner; Anne Nitsche; Alexander Staudt; Frank Steinborn; Christian Bietau; Henning T. Baberg; Michael Niehaus; Jürgen Tebbenjohanns; Melchior Seyfarth; Markus Ferrari; Marc Vorpahl; Ralf Kuhlen; Kerstin Bode; Andreas Bollmann

doi:10.1002/clc.70196

October 1, 2025Clinical CardiologyOpen Access

Management of Antithrombotic Therapy in Patients With Coexisting Atrial Fibrillation and Coronary Artery Disease Who Underwent Percutaneous Coronary Intervention Within the Last Year

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Graphical abstract published by Clinical Cardiology — Graphical abstract · Published by Clinical Cardiology · CC BY

Why the study?

CAD frequently coexists with AF and optimal antithrombotic therapy improves outcomes, but real-world antithrombotic regimens across cohorts needed characterization.

What are the current antithrombotic drug utilization patterns and their association with 12-month MACE in patients with AF and CAD who underwent PCI within the last year?

Structured PICO

What are the current antithrombotic drug utilization patterns and their association with 12-month MACE in patients with AF and CAD who underwent PCI within the last year?

P

Population

3,686 inpatient cases (3,481 from HZL database, 205 from H2 registry) with atrial fibrillation and coronary artery disease who underwent percutaneous coronary intervention (PCI) within the last 12 months.

I

Intervention

Antithrombotic drug regimens (oral anticoagulation and/or antiplatelet therapy)

O

Outcome

Antithrombotic drug utilization rates and rehospitalization for major adverse cardiovascular events (MACE) at 12 monthscomposite

In patients with AF and recent PCI, OAC therapy without adjunctive antiplatelet therapy within the first year is associated with an increased rate of rehospitalization for MACE.

Implication

OAC monotherapy may increase early post-PCI MACE risk in AF+CAD; leaves open optimal antithrombotic strategy for prospective trials.

Abstract

BACKGROUND: Coronary artery disease (CAD) is a common comorbidity in patients with atrial fibrillation (AF), and optimal antithrombotic medication improves clinical outcomes in this high-risk population. The aim of our study was to describe antithrombotic drug regimens in different patient cohorts. METHODS: We investigated data from the prospective Helios Heart registry (H2) and the Heart Center Leipzig routine clinical database (HZL). We included inpatient cases with AF and CAD (hospitalized from March 2021 to July 2024 [H2] or January 2017 to December 2021 [HZL]), who underwent percutaneous coronary intervention (PCI) within the last 12 months. Information on clinical characteristics, coronary interventions, and medication prescribed was obtained from electronic case report forms and/or administrative data based on ICD-10, OPS, and ATC codes. RESULTS: We included 3481 (HZL), and 205 (H2) index cases with comparable baseline characteristics. Overall, 92.5% (HZL) and 87.6% (H2) of patients were on any anticoagulation, and 93.0% (HZL) and 80.2% (H2) were prescribed ≥ 1 antiplatelet agent. There were relevant differences in antithrombotic therapy when stratifying for PCI timing. Factors associated with higher (older age) or lower (comorbidity burden, antiplatelet treatment, prior left atrial appendage occlusion) prescription rates of OAC were identified. OAC therapy without adjunctive antiplatelet therapy was associated with an increased rate of rehospitalization for major adverse cardiovascular events at 12 months (HZL). CONCLUSION: We presented current data on antithrombotic drug utilization in patients with AF and CAD and found comorbidity burden, concomitant antiplatelet treatment and other factors to be associated with lower anticoagulant prescription rates.