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Single direct oral anticoagulant therapy in stable patients with atrial fibrillation beyond 1 year after coronary stent implantation
- 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.
- Subjects :
- medicine.medical_specialty
Gastrointestinal bleeding
Combination therapy
medicine.medical_treatment
Hemorrhage
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Internal medicine
Atrial Fibrillation
Coronary stent
Antithrombotic
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Stroke
business.industry
Anticoagulants
Percutaneous coronary intervention
Atrial fibrillation
medicine.disease
Cardiology
Stents
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Subjects
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