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Anticoagulant and Antiplatelet Therapy Use in 426 Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention and Stent Implantation
Open accessAbstract
Objectives This study was designed to review outcomes in relation to antithrombotic therapy management strategies for patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) with stenting.Background There is limited evidence on the optimal antithrombotic therapy management strategies for patients with AF who undergo PCI with stenting.Methods We reviewed 426 patients (70.9% men, mean age 71.5 +/- 8.5 years) with AF undergoing PCI with stenting between 2001 and 2006. We recorded clinical and demographic characteristics of the patients, stroke risk factors, and antithrombotic therapy use before PCI and at discharge. Clinical follow-up was performed, and all bleeding episodes, thromboembolism, and major adverse cardiac events (MACE) (i.e., death, acute myocardial infarction, or target lesion revascularization) were recorded.Results The most commonly associated comorbidities were hypertension (74.5%), diabetes mellitus (40.2%), chronic renal failure (14.9%), and congestive heart failure (26.7%); 80% of patients had >or=2 stroke risk factors. Of the drugs prescribed at discharge, aspirin plus clopidogrel were used in 174 patients (40.8%), whereas 213 patients (50%) were discharged with triple therapy (coumarins, aspirin, and clopidogrel). Complete follow-up was achieved in 87.5% (median 594 days; range 0 to 2,190). The incidence of adverse events was high (36.6%), with major bleeding in 12.3%, thromboembolic events in 4.2%, and MACE in 32.3%. All-cause mortality was high (22.6%). In a multivariate analysis, non-anticoagulation with coumarins increased mortality (17.8% vs. 27.8%; hazard ratio [HR] = 3.43; 95% confidence interval [CI] 1.61 to 7.54; p = 0.002) and MACE (26.5% vs. 38.7%; HR = 4.9; 95% CI 2.17 to 11.1; p < 0.01) In a Cox-regression analysis, non-anticoagulation (p < 0.01) and age (p = 0.02) were independent predictors of MACE.Conclusions Patients with AF undergoing PCI with stenting represent a high-risk population because of age, comorbidities, and presence of stroke risk factors. These patients have a high mortality and MACE rate, which is reduced by anticoagulation therapy.
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“Approximately 15% of AF patients in contemporary trials 513 and registries [514][515][516] have a history of myocardial 1498 infarction.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [513]
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A Clinical Trial Comparing Three Antithrombotic-Drug Regimens after Coronary-Artery Stenting
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Guidelines for Percutaneous Coronary Interventions
Silber, S., Albertsson, P., Fernández‐Avilés, F., Camici, P. G., Colombo, A., Hamm, C. W., Jørgensen, E. O., Marco, J., Nordrehaug, J.-E., Rużyłło, W., et al. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi138 · Cited by 1,607
Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy
McFadden, E. P., Stabile, E., Regar, E. S., Cheneau, E. F., Ong, A. T. L., Kinnaird, T. D., Suddath, W. O., Weissman, N. J., Torguson, R., Kent, K. M., et al. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17275-9 · Cited by 1,436
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P. F., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castellà, M., Diener, H., Heidbüchel, H., Hendriks, J., et al. (2016) · EP Europace · doi:10.1093/europace/euw295 · Cited by 6,438
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418
2023 ESC Guidelines for the management of acute coronary syndromes
Byrne, R. A., Rossello, X., Coughlan, J. J., Barbato, E., Berry, C., Chieffo, A., Claeys, M. J., Dan, G.-A., Dweck, M. R., Galbraith, M., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad191 · Cited by 5,333
Collet, J.-P., Thiele, H., Barbato, E., Barthélémy, O., Bauersachs, J., Bhatt, D. L., Dendale, P., Dorobantu, M., Edvardsen, T., Folliguet, T., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehaa575 · Cited by 5,037
2014 ESC/EACTS Guidelines on myocardial revascularization
Authors Task Force Members, Windecker, S., Kolh, P., Alfonso, F., Collet, J., Cremer, J., Falk, V., Filippatos, G., Hamm, C. W., Head, S. J., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu278 · Cited by 4,408
Metadata
- Authors
- Ruiz-Nodar, J. M., Marín, F., Hurtado, J. A., Valencia, J., Pinar, E., Pineda, J., Gimeno, J. R., Sogorb, F., Valdés, M., & Lip, G. Y. H.
- Affiliations
- Hospital General Universitario de Alicante Doctor Balmis (ES)
- Instituto de Salud Carlos III (ES)
- Hospital Universitario Virgen de la Arrixaca (ES)
- Birmingham City Hospital (GB)
- Corresponding author
- Lip, Gregory Y.H.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-02
- Volume
- 51
- Issue
- 8
- Pages
- 818-825
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1475865131
- Cited by
- 269
- References
- 25
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 5 · 2022: 3 · 2021: 10 · 2020: 3 · 2019: 10 · 2018: 11 · 2017: 7 · 2016: 16 · 2015: 33 · 2014: 24 · 2013: 27 · 2012: 15
- FWCI
- 24.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Keywords
- atrial fibrillation, percutaneous coronary intervention, coronary stenting, antithrombotic therapy, anticoagulation, antiplatelet therapy, clopidogrel, aspirin, coumarins, triple therapy, major adverse cardiac events, major bleeding, thromboembolism, all-cause mortality, stroke risk factors, dual antiplatelet therapy
- MeSH terms
- Aged, Anticoagulants, Atrial Fibrillation, Female, Heart Diseases, Humans, Male, Platelet Aggregation Inhibitors, Prognosis, Retrospective Studies, Risk Factors, Thromboembolism, Stents, Angioplasty, Balloon, Coronary, Postoperative Hemorrhage
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