Chow JK, Bagai A, Tan MK, Har BJ, Yip AMC, Paniagua M, Elbarouni B, Bainey KR, Paradis JM, Maranda R, Cantor WJ, Eisenberg MJ, Dery JP, Madan M, Cieza T, Matteau A, Roth S, Lavi S, Glanz A, Gao D, Tahiliani R, Welsh RC, Kim HH, Robinson SD, Daneault B, Chong AY, Le May MR, Ahooja V, Gregoire JC, Nadeau PL, Laksman Z, Heilbron B, Yung D, Minhas K, Bourgeois R, Overgaard CB, Bonakdar H, Logsetty G, Lavoie AJ, De LaRochelliere R, Mansour S, Spindler C, Yan AT, and Goodman SG
Background: Selecting the appropriate antithrombotic regimen for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) or have had medically managed acute coronary syndrome (ACS) remains complex. This multi-centre observational study evaluated patterns of antithrombotic therapies utilized among Canadian patients with AF post-PCI or ACS., Methods and Results: By retrospective chart audit, 611 non-valvular AF patients [median (interquartile range) age 76 (69-83) years, CHADS 2 score 2 (1-3)] who underwent PCI or had medically managed ACS between August 2018 and December 2020 were identified by 68 cardiologists across eight provinces in Canada. Overall, triple antithrombotic therapy [TAT: combined oral anticoagulation (OAC) and dual antiplatelet therapy (DAPT)] was the most common initial antithrombotic strategy, with use in 53.8 % of patients, followed by dual pathway therapy (32.7 % received OAC and a P2Y12 inhibitor, and 4.1 % received OAC and aspirin) and DAPT (9.3 %). Median duration of TAT was 30 (7, 30) days. Compared to the previous CONNECT AF + PCI-I program, there was an increased use of dual pathway therapy relative to TAT over time (P-value <.0001). DOACs (direct oral anticoagulants) represented 90.3 % of all OACs used overall, with apixaban being the most utilized (50.5 %). Proton pump inhibitors were used in 57.0 % of all patients, and 70.1 % of patients on ASA. Planned antithrombotic therapies at 1 year were: 76.2 % OAC monotherapy, 8.3 % OAC + ASA, 7.9 % OAC + P2Y12 inhibitor, 4.3 % DAPT, 1.3 % ASA alone, and <1 % triple therapy., Conclusion: In accordance with recent Canadian Cardiovascular Society guideline recommendations, we observed an increased use of dual pathway therapy relative to TAT over time in both AF patients post-PCI (elective and emergent) and in those with medically managed ACS. Additionally, DOACs have become the prevailing form of anticoagulation across all antithrombotic regimens. Our findings suggest that Canadian physicians are integrating evidence-based approaches to optimally manage the bleeding and thrombotic risks of AF patients post-PCI and/or ACS., Competing Interests: Declaration of competing interest James K ChowNone Mary K TanNone Bryan J HarResearch grants and/or speaking consulting honoraria from Abbott, Astra Zeneca, Bayer, BMS/Pfizer, CSL Behring, Novartis, Opsens Amelia MC YipNone Mario PaniaguaNone Basem ElbarouniNone Kevin R Bainey,Research grants and/or speaking consulting honoraria from Astra Zeneca, Bayer, BMS. Jean-Michel ParadisNone Akshay BagaiResearch grants and/or speaking consulting honoraria from Servier, Bayer Inc., BMS/Pfizer, Boehringer Ingelheim, Teleflex, Abbott Vascular, Astra Zeneca, JAMP Pharma, HLS Therapeutics. Robert MarandaResearch grants and/or speaking consulting honoraria from Bayer, Bristol Myers Squibb, CHRC, Novartis, Servier. Investments, Abbvie, Amgen, McKesson Warren J CantorNone Mark J EisenbergNone Jean-Pierre DeryResearch grants and/or speaking consulting honoraria from JAMP Pharma, AstraZeneca, Bayer, BMS-Pfizer, Servier Mina MadanNone Tomas CiezaResearch grants and/or speaking consulting honoraria from Bayer, Boehringer-Ingelheim, Pfizer-BMS, Servier, Lilly, Astra Zeneca Alexis MatteauResearch grants and/or speaking consulting honoraria from Bristol Myers Squibb Sherryn RothNone Shahar LaviNone Anthony GlanzResearch grants and/or speaking consulting honoraria from BMS/Pfizer, Novartis, Bayer, Amgen Dongsheng GaoNone Ravi TahilianiResearch grants and/or speaking consulting honoraria from Pfizer-BMS, Novartis, Bayer, Daiichi Sankyo, Robert C WelshResearch grants and/or speaking consulting honoraria from Astra Zeneca, Bayer, BMS/Pfizer Hahn Hoe KimBMS/Pfizer Simon D RobinsonResearch grants and/or speaking consulting honoraria from Bayer and Servier Benoit DaneaultResearch grants and/or speaking consulting honoraria from BMS/Pfizer, Novartis, Edwards Lifesciences, Bayer, Abbott, Sanofi Aun-Yeong ChongResearch grants and/or speaking consulting honoraria from Servier Michel R Le MayNone Vineeta AhoojaResearch grants and/or speaking consulting honoraria from Amgen, Sanofi, Novo Nordisk, Bayer, Boehringer-Ingelheim, BMS/ Pfizer Jean C GregoireResearch grants and/or speaking consulting honoraria from Bayer, Boehringer Ingelheim, BMS/Pfizer alliance and Servier Pierre-Louis NadeauNone Zachary LaksmanNone Brett HeilbronNone Derek YungResearch grants and/or speaking consulting honoraria from Novartis, Amgen, Boehringer Ingleheim, Pfizer, Abbott, Medtronic, Boston Scientific Kunal MinhasNone Ronald BourgeoisResearch grants and/or speaking consulting honoraria from BMS/Pfizer, Canadian Collaborative Research Network (CCRN), HLS, Novartis Christopher OvergaardNone Hamid BonakdarNone Giridhar LogsettyResearch grants and/or speaking consulting honoraria from BMS/Pfizer Robert DeLaRochelliereNone Samer MansourResearch grants and/or speaking consulting honoraria from Astra-Zeneca, Pfizer, BMS, Sanofi, Amgen, HLS, Boehringer Ingelheim, Servier, Bayer, Abbott Vasculaire, Novartis Caroline SpindlerNone Andrew T YanNone Shaun G GoodmanResearch grant support (e.g., steering committee or data and safety monitoring committee) and/or speaker/consulting honoraria (e.g., advisory boards) from: Amgen, Anthos Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, Daiichi-Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, HLS Therapeutics, JAMP Pharma, Merck, Novartis, Novo Nordisk A/C, Pendopharm/Pharmascience, Pfizer, Regeneron, Sanofi, Servier, Tolmar Pharmaceuticals, Valeo Pharma; and salary support/honoraria from the Heart and Stroke Foundation of Ontario/University of Toronto (Polo) Chair, Canadian Heart Research Centre and MD Primer, Canadian VIGOUR Centre, Cleveland Clinic Coordinating Centre for Clinical Research, Duke Clinical Research Institute, New York University Clinical Coordinating Centre, PERFUSE Research Institute, TIMI Study Group (Brigham Health), (Copyright © 2023 Elsevier Ltd. 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