Comparison Between Long-Term Clinical Outcomes of Vitamin K Antagonist and Direct Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention.

BACKGROUND

Whether direct oral anticoagulants (DOACs) are safer and more effective than vitamin K antagonist (VKA) for preventing thrombotic events in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) remains unknown.

METHODS AND RESULTS

Between April 2011 and March 2014, data from 2,045 consecutive patients who underwent PCI were retrospectively examined. Of them, 129 patients treated with oral anticoagulants (OACs) and antiplatelet agents because of AF were enrolled. Primary bleeding outcome was a composite of major and minor bleeding, as per the Thrombolysis in Myocardial Infarction criteria. Secondary efficacy outcome was a composite outcome of death, myocardial infarction (MI), stroke, and target-lesion revascularization (TLR). Of the 129 patients, VKA was used in 84 and DOACs in 45. The mean time in the therapeutic range for the VKA group was 52.6%. The ratio of CHAD-VASC and HAS-BLED scores ≥3 was similar between the groups (VKA, 90.5%; DOAC, 84.4%; P=0.31 and VKA, 79.8%; DOAC, 68.9%; P=0.17, respectively). During follow-up (median, 1,080 days), the primary bleeding outcome tended to occur less (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.24-1.11, P=0.10) and the composite secondary efficacy outcome significantly less frequently (HR, 0.40; 95% CI, 0.14-0.91; P=0.03) in the DOAC group.

CONCLUSIONS

Compared with DOACs, VKA with poorly controlled INR and antiplatelet agents correlated with adverse outcomes of death, MI, stroke, and TLR in patients undergoing PCI.