Triple antithrombotic therapy versus dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation
- Authors
- Kang, Dong Oh; Yu, Cheol Woong; Kim, Hee Dong; Cho, Jae Young; Joo, Hyung Joon; Choi, Rak Kyong; Park, Jin Sik; Lee, Hyun Jong; Kim, Je Sang; Park, Jae Hyung; Hong, Soon Jun; Lim, Do-Sun
- Issue Date
- Aug-2015
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- atrial fibrillation; drug-eluting stent; dual antiplatelet therapy; triple antithrombotic therapy; warfarin
- Citation
- CORONARY ARTERY DISEASE, v.26, no.5, pp 372 - 380
- Pages
- 9
- Indexed
- SCI
SCIE
SCOPUS
- Journal Title
- CORONARY ARTERY DISEASE
- Volume
- 26
- Number
- 5
- Start Page
- 372
- End Page
- 380
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/7671
- DOI
- 10.1097/MCA.0000000000000242
- ISSN
- 0954-6928
1473-5830
- Abstract
- BackgroundThe optimal antithrombotic regimen in patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation for complex coronary artery disease is unclear. We compared the net clinical outcomes of triple antithrombotic therapy (TAT; aspirin, thienopyridine, and warfarin) and dual antiplatelet therapy (DAPT; aspirin and thienopyridine) in AF patients who had undergone DES implantation.MethodsA total of 367 patients were enrolled and analyzed retrospectively; 131 patients (35.7%) received TAT and 236 patients (64.3%) received DAPT. DAPT and warfarin were maintained for a minimum of 12 and 24 months, respectively. The primary endpoint was the 2-year net clinical outcomes, a composite of major bleeding and major adverse cardiac and cerebral events (MACCE). Propensity score-matching analysis was carried out in 99 patient pairs.ResultsThe 2-year net clinical outcomes of the TAT group were worse than those of the DAPT group (34.3 vs. 21.1%, P=0.006), which was mainly due to the higher incidence of major bleeding (16.7 vs. 4.6%, P<0.001), without any significant increase in MACCE (22.1 vs. 17.7%, P=0.313). In the multivariate analysis, TAT was an independent predictor of worse net clinical outcomes (odds ratio 1.63, 95% confidence interval 1.06-2.50) and major bleeding (odds ratio 3.54, 95% confidence interval 1.65-7.58). After propensity score matching, the TAT group still had worse net clinical outcomes and a higher incidence of major bleeding compared with the DAPT group.ConclusionIn AF patients undergoing DES implantation, prolonged administration of TAT may be harmful due to the substantial increase in the risk for major bleeding without any reduction in MACCE.
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Collections - 2. Clinical Science > Department of Cardiology > 1. Journal Articles
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