Triple Antithrombotic Therapy versus Dual Antiplatelet Therapy in Patients with Atrial Fibrillation undergoing Drug-eluting Stent Implantation

초록

Background Optimal antithrombotic regimen for patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation for complex coronary artery disease is uncertain. The aim of study is to compare the net clinical outcomes between triple antithrombotic therapy group (TAT; aspirin, thienopyridine and warfarin) and dual antiplatelet therapy group (DAPT; aspirin and thienopyridine) in AF patients undergoing DES implantation. Methods Among a total of 367 AF patients undergoing DES implantation, 154 patients (42.0%) received TAT and 213 patients (58.0%) received DAPT. The prescribed antithrombotic regimen was maintained throughout the whole study period (median 2 years). The primary end point was defined as net clinical outcomes, a composite of major bleeding and major adverse cardiac and cerebral events (MACCE). Propensity score-matching analysis was also performed in 99 patient pairs. Results The net clinical outcomes of the TAT group was worse than the DAPT group (34.3% v 21.1%, p=0.006), which was mainly driven by 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 multivariate analysis, the TAT was an independent predictor for worse net clinical outcomes (HR 1.67; 95% CI 1.09-2.57; p=0.018) and major bleeding (HR 3.74; 95% CI 1.74-8.02; p=0.001). After propensity score-matching, TAT group still had worse net clinical outcomes, mainly driven by higher major bleeding, than DAPT group. Conclusions In AF patients undergoing DES implantation, prolonged administration of TAT is associated with worse net clinical outcomes due to the substantial increase in major bleeding without any improvement of MACCE.