Beata Uziębło-Życzkowska1, Paweł Krzesiński1, Małgorzata Maciorowska1, Iwona Gorczyca2,3, Olga Jelonek2,3, Maciej Wójcik4, Robert Błaszczyk4, Agnieszka Kapłon-Cieślicka5, Monika Gawałko5, Tomasz Tokarek6, Renata Rajtar-Salwa6, Jacek Bil7, Michał Wojewódzki7, Anna Szpotowicz8, Małgorzata Krzciuk8, Janusz Bednarski9, Elwira Bakuła-Ostalska9, Anna Tomaszuk-Kazberuk10, Anna Szyszkowska11, Marcin Wełnicki12, Artur Mamcarz12, Beata Wożakowska-Kapłon2,3. 1. Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland. 2. 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland. 3. Collegium Medicum, The Jan Kochanowski University, Kielce, Poland. 4. Department of Cardiology, Medical University of Lublin, Lublin, Poland. 5. 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. 6. Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland. 7. Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland. 8. Department of Cardiology, Regional Hospital, Ostrowiec Świętokrzyski, Poland. 9. Department of Cardiology, St John Paul II Western Hospital, Grodzisk Mazowiecki, Poland. 10. Department of Cardiology, Medical University of Bialystok, Białystok, Poland. 11. Department of Cardiology, University Hospital of Bialystok, Białystok, Poland. 12. 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warsaw, Poland.
Abstract
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. 2021 Cardiovascular Diagnosis and Therapy. All rights reserved.
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. 2021 Cardiovascular Diagnosis and Therapy. All rights reserved.
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