Key result
In a survey of Indian cardiologists, 54.30% most commonly prescribed triple therapy (NOAC plus dual antiplatelet therapy) for patients with atrial fibrillation and acute coronary syndrome or undergoing PCI.
Why the study?
Practice recommendations for antithrombotic regimens in patients with AF and ACS or undergoing PCI are largely consensus-based with limited RCT evidence, leaving Indian practice patterns unclear.
Cross-Sectional (n=151)
Yes
A survey of Indian cardiologists reveals that the majority prescribe triple therapy (NOAC plus dual antiplatelet therapy) for patients with atrial fibrillation and acute coronary syndrome or undergoing PCI, aligning with current guidelines.
Survey data on Indian cardiologists' preferences are hypothesis-generating; prospective studies needed to link patterns with outcomes.
PURPOSE: The management of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) requires appropriate antithrombotic regimens for stroke prevention and in-stent thrombosis. Current practice recommendations are largely based on consensus options as there is limited evidence from randomized clinical trials. Hence, by surveying a group of cardiologists across India, we sought to better understand the current practice patterns of using oral anticoagulants (vitamin K antagonist, VKA or non-vitamin K antagonist oral anticoagulant, NOAC) and antiplatelet therapy in those patients in India. METHODS: A cross-sectional questionnaire-based survey was conducted across India to better understand the clinical practices in AF management. RESULTS: A total of 151 cardiologists participated in this survey. The most commonly prescribed combination therapy in patients with AF and ACS/undergoing PCI was triple therapy (NOAC + dual antiplatelet [aspirin and P2Y12 inhibitor]) (54.30%) followed by NOAC + single antiplatelet (33.11%). Only 11.26% of cardiologists prescribed VKA + dual antiplatelet therapy. Among anticoagulants, cardiologists prescribed NOACs to 66.11% of patients and VKAs to 25.54% of patients. Among P2Y12 inhibitors, ticagrelor (50.99%) and clopidogrel (47.02%) were the most preferred medication. The physician reported patient adherence rates to NOACs were higher compared to VKAs. Around 41.06% of cardiologists reportedly changed antiplatelet therapy for patients from dual antiplatelet to single antiplatelet therapy in three months; 36.42%, in one month; and 19.21% in six months after PCI. Around 61.59% of cardiologists stopped prescribing antiplatelet therapy for patients by one year. CONCLUSION: Our survey demonstrated that the majority of cardiologists used triple therapy (NOAC + dual antiplatelet), followed by NOAC + single antiplatelet for managing patients with AF and ACS or undergoing PCI in line with the available guidelines.
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Kulkarni et al. (2023) conducted a cross-sectional in Atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention (n=151). Anticoagulant and antiplatelet prescribing patterns was evaluated on Most commonly prescribed combination therapy. In a survey of Indian cardiologists, 54.30% most commonly prescribed triple therapy (NOAC plus dual antiplatelet therapy) for patients with atrial fibrillation and acute coronary syndrome or undergoing PCI.
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