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.

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.

• Authors: Laurie-Anne Boivin-Proulx, Ariane Deneault-Marchand, Alexis Matteau, Samer Mansour, François Gobeil, John A Camm, Keith A A Fox, Brian J Potter
• Journal: Clinical cardiology (Clin Cardiol) Vol. 43 Issue 3 Pg. 216-221 (Mar 2020) ISSN: 1932-8737 [Electronic] United States
• PMID: 31850592 (Publication Type: Comparative Study, Journal Article, Observational Study)
• Copyright: © 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

Chemical References

• Anticoagulants
• Fibrinolytic Agents

Topics

• Aged
• Aged, 80 and over
• Anticoagulants (administration & dosage, adverse effects)
• Atrial Fibrillation (diagnosis, drug therapy, epidemiology)
• Coronary Artery Disease (diagnosis, epidemiology, therapy)
• Drug Administration Schedule
• Drug Prescriptions
• Drug Utilization (trends)
• Female
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Guideline Adherence (trends)
• Hemorrhage (chemically induced)
• Humans
• Male
• Middle Aged
• Percutaneous Coronary Intervention (adverse effects, instrumentation)
• Practice Guidelines as Topic
• Practice Patterns, Physicians' (trends)
• Quebec (epidemiology)
• Registries
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Stents
• Thrombosis (diagnosis, epidemiology, prevention & control)
• Time Factors
• Treatment Outcome