A survey of 118 interventional cardiologists revealed significant heterogeneity in antithrombotic management for AF patients undergoing PCI, with 70.3% prescribing triple therapy at discharge for NSTEMI.
Cross-Sectional (n=118)
Yes
There is significant heterogeneity among interventional cardiologists in the antithrombotic management of patients with atrial fibrillation undergoing PCI, highlighting the need for more patient-tailored evidence.
BACKGROUND: Antithrombotic treatment choices are complicated when patients have both atrial fibrillation (AF) and acute coronary syndrome and/or undergo percutaneous coronary intervention (PCI). In this study, we aimed to gain insight into antithrombotic management strategies in daily clinical practice. METHODS: We invited interventional cardiologists to complete the WOEST (What is the Optimal antiplatElet & Anticoagulant Therapy in Patients With Oral Anticoagulation and Coronary StenTing) survey 2018. In this questionnaire, we presented a patient with a non-ST-elevation myocardial infarction (NSTEMI) and an elective PCI case. RESULTS: The results were based on 118 completed questionnaires (response rate 69.4%). In the case of the AF patient with NSTEMI, most cardiologists indicated they would initiate dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) and continue non-vitamin K antagonist oral anticoagulant (NOAC) therapy at admission and during coronary angiography/PCI. At discharge, 70.3% would prescribe triple antithrombotic therapy (oral anticoagulation, acetylsalicylic acid and clopidogrel), mostly for 1 month. One year after NSTEMI, 83.1% would cancel the antiplatelet therapy and prescribe NOAC monotherapy. For the AF patient undergoing elective PCI, 51.7% would start dual antiplatelet therapy prior to the procedure and 52.5% would discontinue NOAC therapy prior to the PCI. At discharge, 55.1% would start triple antithrombotic therapy. Furthermore, 25.4% responded they routinely prescribe a reduced dose of NOAC after discharge. One year after PCI, 89.0% would continue NOAC monotherapy. CONCLUSION: The WOEST survey demonstrated heterogeneity in antithrombotic management strategies among interventional cardiologists. This observed variety mirrors the heterogeneity of the many guidelines and consensus documents. Further research is needed to guide patient-tailored medicine for AF patients undergoing PCI.
Veer et al. (2020) conducted a cross-sectional in Antithrombotic management strategies for atrial fibrillation patients undergoing percutaneous coronary intervention (n=118). Survey on antithrombotic management was evaluated on Reported antithrombotic management strategies. A survey of 118 interventional cardiologists revealed significant heterogeneity in antithrombotic management for AF patients undergoing PCI, with 70.3% prescribing triple therapy at discharge for NSTEMI.