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Time-trends and treatment gaps in the antithrombotic management of patients with atrial fibrillation after percutaneous coronary intervention: Insights from the CHUM AF-STENT Registry.

Boivin-Proulx, L-A; Deneault-Marchand, A; Matteau, A; Mansour, S; Gobeil, F; Camm, JA; Fox, KAA; Potter, BJ (2020) Time-trends and treatment gaps in the antithrombotic management of patients with atrial fibrillation after percutaneous coronary intervention: Insights from the CHUM AF-STENT Registry. Clin Cardiol, 43 (3). pp. 216-221. ISSN 1932-8737 https://doi.org/10.1002/clc.23316
SGUL Authors: Camm, Alan John

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Abstract

BACKGROUND: The management of atrial fibrillation and flutter (AF) patients undergoing percutaneous coronary intervention (PCI) has undergone a rapid recent evolution. In 2016, the Canadian Cardiovascular Society (CCS) published expert recommendations to help guide clinicians in balancing bleeding and thrombotic risks in these patients. HYPOTHESIS: Antithrombotic regimen prescriptions for AF patients undergoing PCI evolved after the publication of the 2016 CCS AF guidelines. METHODS: A prospective cohort of AF patients undergoing PCI with placement of a coronary stent from a single tertiary academic center was analyzed for the recommended antithrombotic regimen at discharge. Prescribing behavior was compared between three time periods (Cohort A [2010-2011]; Cohort B [2014-2015]; Cohort C [2017]) using the χ2 test. In addition, antithrombotic management in Cohorts B and C were compared to guideline-recommended therapy. RESULTS: A total of 459 patients with AF undergoing PCI were identified. Clinical and procedural characteristics were similar between cohorts, with the exception of an increase in drug-eluting stent (DES) use over time (P < .01). Overall, the rate of oral anticoagulation (OAC) increased over time (P < .01), associated with an increase in nonvitamin K OAC prescription (P < .01) and a concomitant decrease in vitamin K antagonist prescription (P < .01). Despite this, the overall rate of anticoagulation remains below what would be predicted with perfect guideline compliance (75% vs 94%, P < .01). CONCLUSION: There has been a dramatic shift in clinical practice for AF patients requiring PCI, with increases in prescription of OAC even in the context of an increase in the use of DES. However, room for further practice optimization still exists.

Item Type: Article
Additional Information: © 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: acute coronary care, antiplatelet therapy, atrial fibrillation, percutaneous coronary intervention, acute coronary care, antiplatelet therapy, percutaneous coronary intervention, atrial fibrillation, Cardiovascular System & Hematology, 1102 Cardiorespiratory Medicine and Haematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Clin Cardiol
ISSN: 1932-8737
Language: eng
Dates:
DateEvent
12 March 2020Published
18 December 2019Published Online
21 November 2019Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 31850592
Web of Science ID: WOS:000503093600001
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111533
Publisher's version: https://doi.org/10.1002/clc.23316

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