Dual antithrombotic therapy with oral anticoagulant and P2Y12 inhibitors in patients with atrial fibrillation after percutaneous coronary intervention

• Published in: Journal of cardiology 2023-09, Vol.82 (3), p.207-214
• Main Authors: Kitahara, Hideki, Yamashita, Daichi, Sato, Takanori, Suzuki, Sakuramaru, Hiraga, Takashi, Yamazaki, Tatsuro, Matsumoto, Tadahiro, Kobayashi, Takahiro, Ohno, Yuji, Harada, Junya, Fukushima, Kenichi, Asano, Tatsuhiko, Ishio, Naoki, Uchiyama, Raita, Miyahara, Hirofumi, Okino, Shinichi, Sano, Masanori, Kuriyama, Nehiro, Yamamoto, Masashi, Sakamoto, Naoya, Kanda, Junji, Kobayashi, Yoshio
• Format: Article
• Language: English
• Subjects: Dual antithrombotic therapy; Low-dose prasugrel; Percutaneous coronary intervention
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2023.06.002

The efficacy and safety of dual antithrombotic therapy (DAT) with oral anticoagulant and P2Y12 inhibitors (P2Y12i) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) have not been well investigated. The purpose of this study was first to evaluate clinical outcomes of DAT with P2Y12i compared with triple antithrombotic therapy (TAT), and then to compare DAT with low-dose prasugrel and DAT with clopidogrel, in patients with AF undergoing PCI. This study was a multicenter, non-interventional, prospective and retrospective registry. A total of 710 patients with AF undergoing PCI between January 2015 and March 2021 at 15 institutions were analyzed. Clinical outcomes within 1 year, including major adverse cardiovascular events (MACE) and major bleeding events (BARC 3 or 5) were compared between patients receiving DAT (n = 239) and TAT (n = 471), and then, compared among prasugrel-DAT (n = 82), clopidogrel-DAT (n = 157), and TAT. The DAT group showed significantly lower incidence of MACE and major bleeding events compared with the TAT group (log-rank p = 0.013 and 0.047). In the multivariable Cox regression analyses, DAT (p = 0.028), acute coronary syndrome (p = 0.025), and anemia (p = 0.015) were independently associated with MACE. In addition, anemia (p = 0.022) was independently associated with, and DAT (p = 0.056) and thrombocytopenia (p = 0.051) tended to be associated with, major bleeding events. When analyzed among the prasugrel-DAT, clopidogrel-DAT, and TAT groups, there were no significant differences in clinical outcomes between the prasugrel-DAT and clopidogrel-DAT groups, and similar trends were observed for both 2 groups in comparison with the TAT group. In AF patients undergoing PCI, DAT was associated with lower incidence of MACE and major bleeding events compared with TAT. In comparison of P2Y12i, there might be no significant difference in the incidence of MACE and bleeding events between prasugrel-based DAT and clopidogrel-based DAT. [Display omitted] •Dual antithrombotic therapy (DAT) can reduce the risk of major adverse cardiovascular events and bleeding events compared with triple therapy.•Low-dose prasugrel might be similar to clopidogrel in reducing clinical events.•Prasugrel-DAT can be selected as antithrombotic therapy in atrial fibrillation patients after percutaneous coronary intervention.