Key result
In AF patients undergoing PCI, inappropriate low doses of NOACs were used in 71% of subjects on rivaroxaban and 67% on apixaban, and triple antithrombotic therapy was frequently chosen.
Why the study?
Although triple antithrombotic therapy is recommended in AF patients undergoing PCI, guidelines also allow dual therapy, prompting assessment of real-world practice across 10 cardiology departments and its guideline adherence.
Observational (n=359)
Yes
Real-world data shows frequent over-prescription of triple antithrombotic therapy and inappropriate under-dosing of NOACs (rivaroxaban and apixaban) in AF patients undergoing PCI, highlighting poor guideline adherence.
Reveals gaps in real-world antithrombotic adherence for AF-PCI; leaves open effectiveness of targeted interventions to improve dosing.
BACKGROUND: Although triple antithrombotic therapy (TAT) is recommended in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), guidelines allow an option of dual antithrombotic therapy (DAT). This study assesses the everyday practice of 10 cardiology departments in antithrombotic therapy in AF patients undergoing PCI and its agreement with current guidelines. METHODS: This analysis included medical data of AF patients enrolled in the prospective, observational registry (The POLish Atrial Fibrillation-POL-AF) that underwent PCI [elective or due to acute coronary syndrome (ACS)]. RESULTS: Of the 3,999 consecutive subjects included, a final analysis was performed on 359 patients that underwent PCI: 148 with urgent PCI due to ACSand 211 patients with elective PCI. Eighty patients in the ACS-group and 120 patients in the elective-PCI group were treated with TAT, although guidelines also allowed DAT. Of 316 patients treated with oral anticoagulants as a part of combination therapy, 275 were on non-vitamin K antagonist oral anticoagulant (NOAC). Reduced doses of NOAC were used in 74 patients treated with rivaroxaban, 60 patients with dabigatran, and 54 patients with apixaban. The proportion of patients treated with reduced NOAC doses adequately to the guidelines was 29%, 100%, and 33% for rivaroxaban, dabigatran, and apixaban, respectively. Inappropriate low doses of NOACs were used in 71% of subjects on rivaroxaban and 67% on apixaban. CONCLUSIONS: In patients with AF undergoing PCI, NOACs are definitely preferred over vitamin-K antagonists (VKAs) in TAT/DAT, and an aggressive antithrombotic strategy with TAT is frequently chosen even if DAT is permissible by the guidelines. Label adherence of using reduced NOAC dose during combination therapy is not satisfactory for apixaban and rivaroxaban and probably results from too cautious an approach to the known indications for reduced therapy. The study is registered in the database Clinical Trials-NCT04419012.
No takes yet. Share an insight, caveat, or question.
Uziębło‐Życzkowska et al. (2021) conducted an observational in Atrial fibrillation undergoing percutaneous coronary intervention (PCI) (n=359). Antithrombotic therapy (Triple vs Dual, NOAC vs VKA, and NOAC dosing) was evaluated on Everyday practice of antithrombotic therapy and its agreement with current guidelines. In AF patients undergoing PCI, inappropriate low doses of NOACs were used in 71% of subjects on rivaroxaban and 67% on apixaban, and triple antithrombotic therapy was frequently chosen.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: