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Combined drug therapy advised for AF patients undergoing PCI
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Vitamin K antagonists should not be withdrawn in patients with atrial fibrillation undergoing PCI, and combined anticoagulant and antiplatelet treatment is warranted because most patients are at high risk for stroke, according to recent study results published in Catheterization and Cardiovascular Interventions.
The prospective, multicenter study was conducted by researchers of the AFCAS study group. In all, 963 consecutive patients with history of or ongoing AF undergoing PCI were included. In 49.1% of patients, AF was permanent, and in 70% of patients, the associated risk for stroke, as defined by a CHADS2 score ≥2, was moderate to high. At the time of enrollment, 69.3% of patients were on vitamin K antagonist therapy.
Overall occurrence of in-hospital MACE was 4.5%, with CV death in 1.9%, urgent revascularization in 1.5% and stroke/arterial thromboembolism in 0.6%. Bleeding complications occurred in 7.1% of patients and were severe in 2.5%. No risk factor was independently associated with bleeding events.
The use of glycoprotein IIb/IIIa antagonists significantly predicted MACE (HR=8.06; 95% CI, 1.14-56.96), as did female gender (HR=9.18; 95% CI, 1.13-74.16). Treatment with clopidogrel (Plavix, Sanofi-Aventis) significantly decreased the likelihood of MACE (HR=0.017; 95% CI, 0.001-0.538).
Researchers said present management appears to follow current recommendations, which may account for the limited occurrence of in-hospital adverse ischemic and bleeding events.
“Whether excessive antithrombotic treatment in patients at low to moderate risk will translate into excessive bleeding complications during follow-up will be evaluated in analysis of 12-month [study] outcome data,” they wrote.
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