What does this research mean for the field?

In patients with atrial fibrillation and stable coronary artery disease beyond 3 years after PCI, oral anticoagulant monotherapy significantly reduces the risk of composite clinical outcomes compared to oral anticoagulant plus single antiplatelet therapy, primarily driven by a 50% reduction in major bleeding. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 22, 2022Frontiers in Cardiovascular MedicineOpen Access

Net clinical benefit of antithrombotic therapy for atrial fibrillation patients with stable coronary artery disease

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation and stable coronary artery disease after percutaneous coronary intervention (n=7003). Intervention: Oral anticoagulant (OAC) monotherapy vs. Oral anticoagulant plus single antiplatelet therapy (SAPT). Primary outcome: Composite clinical outcomes (ischemic stroke, myocardial infarction, and major bleeding) at 3-years post-PCI (HR 0.762, 95% CI 0.607-0.950).

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Key result

OAC monotherapy linked to ~24% fewer composite events vs OAC plus SAPT, driven by less bleeding.

HR 0.762
95% CI 0.607-0.950
n=7,003

Why the study?

It has not been studied whether the net clinical benefit of antithrombotic treatment options differs depending on the elapsed time from the index PCI in AF patients with stable CAD.

Study Design

Type

Observational (n=7,003)

Multicenter

Yes

PICO

Population

7,003 patients with atrial fibrillation and stable coronary artery disease at 1- and 3-years after percutaneous coronary intervention, followed for a median of 2.3 to 2.5 years.

Exposure / Comparator

Oral anticoagulant (OAC) monotherapy vs Oral anticoagulant plus single antiplatelet therapy (SAPT)

Primary Outcome

Composite clinical outcomes (ischemic stroke, myocardial infarction, and major bleeding) at 3-years post-PCI — HR 0.762 (0.607-0.950)

Main Result

Hazard Ratio: 0.762 (95% CI 0.607–0.95)

Limitations

Possibility of residual confounding despite propensity score matching
Lack of information on coronary stents, PCI complexity, and remaining significant coronary lesions
Exclusion of patients who died within 1 or 3 years or who received repeated PCI
OAC monotherapy and OAC plus SAPT do not represent the majority of prescriptions in AF patients with stable CAD in Korea
Lack of laboratory findings such as serum creatinine to evaluate renal dysfunction
Higher proportion of reduced dose DOAC in the OAC plus SAPT group compared to the OAC monotherapy group

Implication

May support OAC monotherapy to reduce bleeding in stable post-PCI AF; leaves open need for randomized confirmation.

Abstract

Objectives: To compare the net clinical benefit of oral anticoagulant (OAC) monotherapy to OAC plus single antiplatelet therapy (SAPT) in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) at 1- and 3-year after percutaneous coronary intervention (PCI). Background: It has not been studied whether the net clinical benefit of the antithrombotic treatment options differs depending on the elapsed time from the index PCI. Methods: Using the Korean nationwide claims database, we included AF patients who underwent PCI from 2009 to 2019 and constructed two cohorts: 1- and 3-year after PCI. In each cohort, the baseline characteristics of two groups were balanced using propensity score weighting. Ischemic stroke, myocardial infarction, major bleeding, and composite clinical outcomes were analyzed. Results: = 2,128) showed comparable results for ischemic stroke and myocardial infarction, but OAC monotherapy was associated with a lower risk of composite clinical outcomes (HR 0.762, 95% CI 0.607-0.950), mainly driven by the reduction of major bleeding risk (HR 0.498, 95% CI 0.345-0.701). Conclusion: Oral anticoagulant monotherapy may be a comparable choice for patients with AF and stable CAD compared to OAC plus SAPT. In patients with stable CAD more than 3-year after index PCI, OAC monotherapy would be a better choice, being associated with less major bleeding and a positive net clinical benefit.

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Published by Frontiers in Cardiovascular Medicine · CC BY

Cite This Study

Lee et al. (2022) conducted an observational in Atrial fibrillation and stable coronary artery disease after percutaneous coronary intervention (n=7,003). Oral anticoagulant (OAC) monotherapy vs. Oral anticoagulant plus single antiplatelet therapy (SAPT) was evaluated on Composite clinical outcomes (ischemic stroke, myocardial infarction, and major bleeding) at 3-years post-PCI (HR 0.762, 95% CI 0.607-0.950). In patients with atrial fibrillation and stable coronary artery disease 3 years after PCI, OAC monotherapy reduced the risk of composite clinical outcomes by 24% (HR 0.762) compared to OAC plus SAPT, driven by reduced major bleeding.

synapsesocial.com/papers/6ac4565a5a79422c1052fdd7 https://doi.org/10.3389/fcvm.2022.991293