Background: Antithrombotic management of patients with AF/Flutter requiring angioplasty is controversial and there is limited evidence to guide recommendations. Moreover, novel antithrombotic therapies have recently become available that may have led to increased practice variability. Methods: We undertook an international multicenter retrospective study of an unselected AF/Flutter population treated with PCI. Only patients with additional non-AF/Flutter indications for or an absolute contraindication to anticoagulation were excluded. The primary measures of interest are antiplatelet and anticoagulant prescriptions at hospital discharge. Active prescriptions and clinical endpoints were followed up to 1 year. Temporal trends in prescription patterns were compared between Early (2010-2011) and Late (2014-2015) Cohorts using the Fischer exact test and a two-tailed α of 0.05. Results: We identi ed 412 cases (124 Early Cohort; 279 Late Cohort) with 70% men, age 73.1±9.5 years overall. Median (IQR) CHADS and HASBLED scores were 2 (1-3) and 1 (1-2), respectively. Baseline clinical characteristics were similar between cohorts. A total of 501 lesions were treated with a signi cant increase in the use of DES over the study period (p<0.0001). A greater proportion of patients in the late cohort were anticoagulated at baseline (63% vs 43%, p<0.001). In addition, 13% were treated with DOACS and 12% with novel P2Y12 inhibitors at discharge in the late cohort vs none in the Early Cohort (p<0.0001 for both comparisons). There was no difference in the rate of VKA prescription at presentation or discharge. Conclusions: Although the clinical characteristics of AF/Flutter patients haven’t changed, signi cantly more patients are now treated with anticoagulation at presentation and at discharge, owing to uptake of DOAC therapy, combined with greater variability in P2Y12 inhibitor prescription at discharge and increasing use of DES in AF/Flutter patients.
TIME-TRENDS IN ANTITHROMBOTIC MANAGEMENT OF PATIENTS WITH AF/FLUTTER TREATED WITH CORONARY STENTS: AN INTERNATIONAL MULTICENTER RESTROSPECTIVE ANALYSIS
ANDO', Giuseppe;VIRGA, VITTORIO;
2017-01-01
Abstract
Background: Antithrombotic management of patients with AF/Flutter requiring angioplasty is controversial and there is limited evidence to guide recommendations. Moreover, novel antithrombotic therapies have recently become available that may have led to increased practice variability. Methods: We undertook an international multicenter retrospective study of an unselected AF/Flutter population treated with PCI. Only patients with additional non-AF/Flutter indications for or an absolute contraindication to anticoagulation were excluded. The primary measures of interest are antiplatelet and anticoagulant prescriptions at hospital discharge. Active prescriptions and clinical endpoints were followed up to 1 year. Temporal trends in prescription patterns were compared between Early (2010-2011) and Late (2014-2015) Cohorts using the Fischer exact test and a two-tailed α of 0.05. Results: We identi ed 412 cases (124 Early Cohort; 279 Late Cohort) with 70% men, age 73.1±9.5 years overall. Median (IQR) CHADS and HASBLED scores were 2 (1-3) and 1 (1-2), respectively. Baseline clinical characteristics were similar between cohorts. A total of 501 lesions were treated with a signi cant increase in the use of DES over the study period (p<0.0001). A greater proportion of patients in the late cohort were anticoagulated at baseline (63% vs 43%, p<0.001). In addition, 13% were treated with DOACS and 12% with novel P2Y12 inhibitors at discharge in the late cohort vs none in the Early Cohort (p<0.0001 for both comparisons). There was no difference in the rate of VKA prescription at presentation or discharge. Conclusions: Although the clinical characteristics of AF/Flutter patients haven’t changed, signi cantly more patients are now treated with anticoagulation at presentation and at discharge, owing to uptake of DOAC therapy, combined with greater variability in P2Y12 inhibitor prescription at discharge and increasing use of DES in AF/Flutter patients.Pubblicazioni consigliate
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