Comparison of Different Antithrombotic Regimens for Patients With Atrial Fibrillation Undergoing Drug-Eluting Stent Implantation

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Author(s)

    • GAO Fei
    • Department of Cardiology, An Zhen Hospital, Capital Medical University
    • ZHOU Yu Jie
    • Department of Cardiology, An Zhen Hospital, Capital Medical University
    • WANG Zhi Jian
    • Department of Cardiology, An Zhen Hospital, Capital Medical University
    • SHEN Hua
    • Department of Cardiology, An Zhen Hospital, Capital Medical University
    • LIU Xiao Li
    • Department of Cardiology, An Zhen Hospital, Capital Medical University
    • NIE Bin
    • Department of Cardiology, An Zhen Hospital, Capital Medical University
    • YAN Zhen Xian
    • Department of Cardiology, An Zhen Hospital, Capital Medical University
    • YANG Shi Wei
    • Department of Cardiology, An Zhen Hospital, Capital Medical University
    • DE JIA An
    • Department of Cardiology, An Zhen Hospital, Capital Medical University
    • YU Miao
    • Department of Cardiology, An Zhen Hospital, Capital Medical University

Abstract

<b><i>Background:</i></b> The optimal antithrombotic strategy for patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation is unknown. <b><i>Methods and Results:</i></b> The 622 consecutive AF patients undergoing DES implantation were prospectively enrolled. Among them, 142 patients (TT group) continued triple antithrombotic therapy comprising aspirin, clopidogrel and warfarin after discharge; 355 patients (DT group) had dual antiplatelet therapy; 125 patients (WS group) were discharged with warfarin and a single antiplatelet agent. Target INR was set as 1.8-2.5 and was regularly monitored after discharge. The TT group had a significant reduction in stroke and major adverse cardiac and cerebral events (MACCE) (8.8% vs 20.1% vs 14.9%, P=0.010) as compared with either the DT or WS group. In the Cox regression analysis, administration with warfarin (hazard ratio (HR) 0.49; 95% confidence interval (CI) 0.31-0.77; P=0.002) and baseline CHADS<sub>2</sub> score ≥2 (HR 2.09; 95%CI 1.27-3.45; P=0.004) were independent predictors of MACCE. Importantly, the incidence of major bleeding was comparable among 3 groups (2.9% vs 1.8% vs 2.5%, P=0.725), although the overall bleeding rate was increased in the TT group. Kaplan-Meier analysis indicated that the TT group was associated with the best net clinical outcome. <b><i>Conclusions:</i></b> The cardiovascular benefits of triple antithrombotic therapy were confirmed by reducing the MACCE rate, and its major bleeding risk might be acceptable if the INR is closely monitored. (<i>Circ J</i> 2010; <b>74:</b> 701-708)<br>

Journal

  • Circulation Journal

    Circulation Journal 74(4), 701-708, 2010-03-25

    The Japanese Circulation Society

References:  34

Cited by:  3

Codes

  • NII Article ID (NAID)
    10026472392
  • NII NACSIS-CAT ID (NCID)
    AA11591968
  • Text Lang
    ENG
  • Article Type
    Journal Article
  • ISSN
    13469843
  • Data Source
    CJP  CJPref  J-STAGE 
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