Author + information
- Dieter Fischer1,
- Maximilian von Fircks2,
- Matthias Paul2,
- Ali Yilmaz2,
- Johannes Waltenberger2 and
- Alexander Samol2
Due to growing incidence of both, atrial fibrillation and coronary artery disease, more patients need a triple-therapy (TT)consisting of dual antiplatelet therapy and anticoagulation after PCI. Existing data on duration and intensity of TT is scarce and conflicting. The ESC-guidelines recommend duration and intensity for TT after PCI, but nearly all recommendations are LOE-C due to limited data. This study evaluated the safety and efficacy of short TT after PCI in patients with atrial fibrillation.
Patients with PCI and indication for oral anticoagulation were included in this study between Nov. 2012 and Mar. 2015. All patients received the Xience® DES (with CE mark for 3 months of DAPT) and were treated after PCI with a consistent regimen as follow: aspirin (100 mg od) for 1 month and clopidogrel (75 mg od) for 3 months, and phenprocoumon lifelong. Follow-up was performed to evaluate the safety and efficacy of this regimen by telephone interview.
88 patients were included (64 men, age 73.8 + 9.1 y), mean follow-up was 14.5 + 9 months. Mean CHA2DS2-Vasc-Score was 4.1 + 1.5, mean HASBLED-Score was 3.1 + 0.6. In sum 33 adverse events occurred in 31 patients, 11 patients died during follow-up (not related to bleeding or myocardial infarction). Other adverse events were as follow: NSTEMI (n=5, target lesion failure n=1), unstable angina (n=2), ischemic stroke (n=3), intracranial bleeding (n=1), groin bleeding (n=4), GI-bleeding (n=5) and epistaxis (n=2). There was no stent thrombosis reported. There was no difference in occurrence of adverse events in regard to the intensity and timepoint of treatment. CHA2DS2-Vasc-Score and HASBLED-Score were independent predictors for the occurrence of adverse events.
This study could show that a short TT after PCI is safe, no stent thrombosis occurred. Bleeding events emerged in all phases of this regimen (TT, clopidogrel and phenprocoumon or phenprocoumon alone), notably there was no increase in bleeding during triple-therapy. Patients with high CHA2DS2-Vasc-Score and/or HASBLED-Score are a high risk for adverse events, therefore a strict benefit-risk consideration should be made in these patients before starting a triple-therapy.
CORONARY: PCI Outcomes