Antithrombotic Therapy and Outcomes After ICD Implantation in Patients With Atrial Fibrillation and Coronary Artery Disease: An Analysis From the National Cardiovascular Data Registry (NCDR) ®

BACKGROUND: Management of antithrombotic agents after implantable cardioverter defibrillator implantation is challenging, particularly among patients with atrial fibrillation and coronary artery disease. METHODS AND RESULTS: Using data from National Cardiovascular Data Registry(®) Implantable Cardioverter Defibrillator Registry(™) linked with Medicare claims data, we identified 25 180 patients with atrial fibrillation and coronary artery disease who underwent implantable cardioverter defibrillator implantation. Patients were categorized into 5 different groups according to antithrombotic agents prescribed at discharge (any 1 antiplatelet agent [A, n=6538], dual antiplatelet therapy [DA, n=3414], warfarin [n=5264], warfarin+A [n=7994], warfarin+DA [n=1970]). We assessed the primary outcomes occurring within 30 days of hospital discharge. Combinations of DA (adjusted hazard ratio [HR]: 1.39; 95% CI: 1.03 to 1.87), warfarin+A (adjusted HR: 1.32; 95% CI: 1.03 to 1.69), and warfarin+DA (adjusted HR: 2.03; 95% CI: 1.49 to 2.77) were associated with a higher bleeding risk. The risk of major adverse cardiovascular events was higher in patients discharged with A (adjusted HR: 1.69; 95% CI: 1.33 to 2.16), DA (adjusted HR: 2.17; 95% CI: 1.66 to 2.83), and DA+warfarin (adjusted HR: 1.61; 1.16 to 2.24). There was no association between postdischarge antithrombotic agents and thromboembolic events or device-related complications. CONCLUSIONS: Short-term bleeding risk and major adverse cardiovascular events differ with usage patterns of antithrombotic agents, while the risk of thromboembolic events and device-related complications is relatively constant. These data may help clinicians balance risks and benefits when choosing antithrombotic therapy following implantable cardioverter defibrillator implantation.