Antithrombotic Therapy in Patients With Atrial Fibrillation After Percutaneous Coronary Intervention During 2-Year Follow-Up, from a Nationwide Population Study

Jiesuck Park, Eue-Keun Choi, Kyung-Do Han, You-Jung Choi, So-Ryoung Lee, Myung-Jin Cha, Jeehoon Kang, Kyung Woo Park, Seil Oh, Gregory Y H Lip

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) are recommended to receive oral anticoagulants (OAC) and concomitant antiplatelet agents followed by OAC monotherapy continued beyond a year after PCI. However, long-term prescription patterns of antithrombotic therapy in real-world clinical practice were not fully investigated. From the National Health Insurance Service database of Korea, we obtained records of patients with AF who underwent PCI between 2009 and 2013. Patients without repeated PCI or death within 2 years following the procedure were included. Prescription records of antithrombotic therapy including anticoagulants and antiplatelet agents were reviewed at 3-month intervals after discharge. We investigated 8,891 patients. At discharge, 76.1% of the patients received dual antiplatelet therapy (DAPT) and only 17.1% received OAC. Although the proportion of patients receiving DAPT gradually decreased, >70% of patients received only antiplatelet agents (DAPT or single antiplatelet therapy) a year after PCI. During the 2-year follow-up, the proportion of patients receiving OAC remained <20%, and only 1.5% of the patients received OAC monotherapy a year after PCI. Female gender, previous myocardial infarction, peripheral vascular disease, and prescription of DAPT at discharge were associated with underprescription of OAC a year after PCI. In conclusion, a significant proportion (76%) of patients with AF who underwent PCI were not prescribed OAC at discharge despite the high risk of stroke contrary to the current guidelines. Most patients continued to receive antiplatelet agents without OAC beyond the 1-year time point after PCI.

OriginalsprogEngelsk
TidsskriftThe American Journal of Cardiology
Vol/bind123
Udgave nummer12
Sider (fra-til)1921-1926
Antal sider6
ISSN0002-9149
DOI
StatusUdgivet - 15 jun. 2019

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Percutaneous Coronary Intervention
Atrial Fibrillation
Anticoagulants
Population
Platelet Aggregation Inhibitors
Therapeutics
Prescriptions
National Health Programs
Peripheral Vascular Diseases
Korea
Stroke
Myocardial Infarction
Databases
Guidelines

Citer dette

Park, Jiesuck ; Choi, Eue-Keun ; Han, Kyung-Do ; Choi, You-Jung ; Lee, So-Ryoung ; Cha, Myung-Jin ; Kang, Jeehoon ; Park, Kyung Woo ; Oh, Seil ; Lip, Gregory Y H. / Antithrombotic Therapy in Patients With Atrial Fibrillation After Percutaneous Coronary Intervention During 2-Year Follow-Up, from a Nationwide Population Study. I: The American Journal of Cardiology. 2019 ; Bind 123, Nr. 12. s. 1921-1926.
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title = "Antithrombotic Therapy in Patients With Atrial Fibrillation After Percutaneous Coronary Intervention During 2-Year Follow-Up, from a Nationwide Population Study",
abstract = "Patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) are recommended to receive oral anticoagulants (OAC) and concomitant antiplatelet agents followed by OAC monotherapy continued beyond a year after PCI. However, long-term prescription patterns of antithrombotic therapy in real-world clinical practice were not fully investigated. From the National Health Insurance Service database of Korea, we obtained records of patients with AF who underwent PCI between 2009 and 2013. Patients without repeated PCI or death within 2 years following the procedure were included. Prescription records of antithrombotic therapy including anticoagulants and antiplatelet agents were reviewed at 3-month intervals after discharge. We investigated 8,891 patients. At discharge, 76.1{\%} of the patients received dual antiplatelet therapy (DAPT) and only 17.1{\%} received OAC. Although the proportion of patients receiving DAPT gradually decreased, >70{\%} of patients received only antiplatelet agents (DAPT or single antiplatelet therapy) a year after PCI. During the 2-year follow-up, the proportion of patients receiving OAC remained <20{\%}, and only 1.5{\%} of the patients received OAC monotherapy a year after PCI. Female gender, previous myocardial infarction, peripheral vascular disease, and prescription of DAPT at discharge were associated with underprescription of OAC a year after PCI. In conclusion, a significant proportion (76{\%}) of patients with AF who underwent PCI were not prescribed OAC at discharge despite the high risk of stroke contrary to the current guidelines. Most patients continued to receive antiplatelet agents without OAC beyond the 1-year time point after PCI.",
author = "Jiesuck Park and Eue-Keun Choi and Kyung-Do Han and You-Jung Choi and So-Ryoung Lee and Myung-Jin Cha and Jeehoon Kang and Park, {Kyung Woo} and Seil Oh and Lip, {Gregory Y H}",
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Antithrombotic Therapy in Patients With Atrial Fibrillation After Percutaneous Coronary Intervention During 2-Year Follow-Up, from a Nationwide Population Study. / Park, Jiesuck; Choi, Eue-Keun; Han, Kyung-Do; Choi, You-Jung; Lee, So-Ryoung; Cha, Myung-Jin; Kang, Jeehoon; Park, Kyung Woo; Oh, Seil; Lip, Gregory Y H.

I: The American Journal of Cardiology, Bind 123, Nr. 12, 15.06.2019, s. 1921-1926.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Antithrombotic Therapy in Patients With Atrial Fibrillation After Percutaneous Coronary Intervention During 2-Year Follow-Up, from a Nationwide Population Study

AU - Park, Jiesuck

AU - Choi, Eue-Keun

AU - Han, Kyung-Do

AU - Choi, You-Jung

AU - Lee, So-Ryoung

AU - Cha, Myung-Jin

AU - Kang, Jeehoon

AU - Park, Kyung Woo

AU - Oh, Seil

AU - Lip, Gregory Y H

PY - 2019/6/15

Y1 - 2019/6/15

N2 - Patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) are recommended to receive oral anticoagulants (OAC) and concomitant antiplatelet agents followed by OAC monotherapy continued beyond a year after PCI. However, long-term prescription patterns of antithrombotic therapy in real-world clinical practice were not fully investigated. From the National Health Insurance Service database of Korea, we obtained records of patients with AF who underwent PCI between 2009 and 2013. Patients without repeated PCI or death within 2 years following the procedure were included. Prescription records of antithrombotic therapy including anticoagulants and antiplatelet agents were reviewed at 3-month intervals after discharge. We investigated 8,891 patients. At discharge, 76.1% of the patients received dual antiplatelet therapy (DAPT) and only 17.1% received OAC. Although the proportion of patients receiving DAPT gradually decreased, >70% of patients received only antiplatelet agents (DAPT or single antiplatelet therapy) a year after PCI. During the 2-year follow-up, the proportion of patients receiving OAC remained <20%, and only 1.5% of the patients received OAC monotherapy a year after PCI. Female gender, previous myocardial infarction, peripheral vascular disease, and prescription of DAPT at discharge were associated with underprescription of OAC a year after PCI. In conclusion, a significant proportion (76%) of patients with AF who underwent PCI were not prescribed OAC at discharge despite the high risk of stroke contrary to the current guidelines. Most patients continued to receive antiplatelet agents without OAC beyond the 1-year time point after PCI.

AB - Patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) are recommended to receive oral anticoagulants (OAC) and concomitant antiplatelet agents followed by OAC monotherapy continued beyond a year after PCI. However, long-term prescription patterns of antithrombotic therapy in real-world clinical practice were not fully investigated. From the National Health Insurance Service database of Korea, we obtained records of patients with AF who underwent PCI between 2009 and 2013. Patients without repeated PCI or death within 2 years following the procedure were included. Prescription records of antithrombotic therapy including anticoagulants and antiplatelet agents were reviewed at 3-month intervals after discharge. We investigated 8,891 patients. At discharge, 76.1% of the patients received dual antiplatelet therapy (DAPT) and only 17.1% received OAC. Although the proportion of patients receiving DAPT gradually decreased, >70% of patients received only antiplatelet agents (DAPT or single antiplatelet therapy) a year after PCI. During the 2-year follow-up, the proportion of patients receiving OAC remained <20%, and only 1.5% of the patients received OAC monotherapy a year after PCI. Female gender, previous myocardial infarction, peripheral vascular disease, and prescription of DAPT at discharge were associated with underprescription of OAC a year after PCI. In conclusion, a significant proportion (76%) of patients with AF who underwent PCI were not prescribed OAC at discharge despite the high risk of stroke contrary to the current guidelines. Most patients continued to receive antiplatelet agents without OAC beyond the 1-year time point after PCI.

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U2 - 10.1016/j.amjcard.2019.03.024

DO - 10.1016/j.amjcard.2019.03.024

M3 - Journal article

VL - 123

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EP - 1926

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

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