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Single direct oral anticoagulant therapy in stable patients with atrial fibrillation beyond 1 year after coronary stent implantation

Authors :
Ju Youn Kim
Yong-Seog Oh
Tae-Seok Kim
Youmi Hwang
Young Choi
Ji-Hoon Kim
Man Young Lee
Sung Hwan Kim
Sung-Won Jang
Yunhee Lee
Sunhwa Kim
Source :
Heart. 108:285-291
Publication Year :
2021
Publisher :
BMJ, 2021.

Abstract

ObjectiveOptimal antithrombotic therapy in patients with atrial fibrillation (AF) beyond 1 year after coronary stent implantation has not been well established in the era of direct oral anticoagulant (DOAC).MethodsUsing Korean National Health Insurance Service data, we analysed 4294 patients with AF who were prescribed DOAC beyond 1 year after coronary stent implantation. Subjects were classified into the monotherapy group (DOAC single therapy, n=1221) or the combination therapy group (DOAC with an antiplatelet agent, n=3073). The primary ischaemic endpoint was defined as a composite of cardiovascular death, myocardial infarction, stroke or systemic thromboembolism. The secondary endpoints were all-cause death, major bleeding defined as a bleeding event requiring hospitalisation and net adverse clinical events. Propensity score matching was performed to balance baseline covariates.ResultsAmong included patients, 94% had drug-eluting coronary stents. During a median follow-up of 19 (7–32) months, the monotherapy group had a similar risk of the primary ischaemic endpoint (HR 0.828, 95% CI 0.660 to 1.038) and all-cause death (HR 1.076, 95% CI 0.895 to 1.294) compared with the combination therapy group. Risk of major bleeding was lower in the monotherapy group (HR 0.690, 95% CI 0.481 to 0.989), which was mostly driven by reduced gastrointestinal bleeding (HR 0.562, 95% CI 0.358 to 0.883). There was no significant difference in net adverse clinical events between the two groups.ConclusionsDOAC monotherapy showed similar efficacy in preventing ischaemic events and was associated with lower major bleeding events compared with combination therapy in patients with AF beyond 1 year after coronary stent implantation.

Details

ISSN :
1468201X and 13556037
Volume :
108
Database :
OpenAIRE
Journal :
Heart
Accession number :
edsair.doi.dedup.....61de7aff3a1004680ded468145db7ccc
Full Text :
https://doi.org/10.1136/heartjnl-2020-318750