接受经皮冠状动脉介入治疗的心房颤动患者的抗栓治疗，包括遵循现行指南——来自波兰心房颤动（POL-AF）注册研究的数据
Antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, including compliance with current guidelines-data from the POLish Atrial Fibrillation (POL-AF) Registry.
作者信息
Uziębło-Życzkowska Beata, Krzesiński Paweł, Maciorowska Małgorzata, Gorczyca Iwona, Jelonek Olga, Wójcik Maciej, Błaszczyk Robert, Kapłon-Cieślicka Agnieszka, Gawałko Monika, Tokarek Tomasz, Rajtar-Salwa Renata, Bil Jacek, Wojewódzki Michał, Szpotowicz Anna, Krzciuk Małgorzata, Bednarski Janusz, Bakuła-Ostalska Elwira, Tomaszuk-Kazberuk Anna, Szyszkowska Anna, Wełnicki Marcin, Mamcarz Artur, Wożakowska-Kapłon Beata
机构信息
Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.
1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland.
出版信息
Cardiovasc Diagn Ther. 2021 Feb;11(1):14-27. doi: 10.21037/cdt-20-839.
BACKGROUND
Although triple antithrombotic therapy (TAT) is recommended in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), guidelines allow an option of dual antithrombotic therapy (DAT). This study assesses the everyday practice of 10 cardiology departments in antithrombotic therapy in AF patients undergoing PCI and its agreement with current guidelines.
METHODS
This analysis included medical data of AF patients enrolled in the prospective, observational registry (The POLish Atrial Fibrillation-POL-AF) that underwent PCI [elective or due to acute coronary syndrome (ACS)].
RESULTS
Of the 3,999 consecutive subjects included, a final analysis was performed on 359 patients that underwent PCI: 148 with urgent PCI due to ACSand 211 patients with elective PCI. Eighty patients in the ACS-group and 120 patients in the elective-PCI group were treated with TAT, although guidelines also allowed DAT. Of 316 patients treated with oral anticoagulants as a part of combination therapy, 275 were on non-vitamin K antagonist oral anticoagulant (NOAC). Reduced doses of NOAC were used in 74 patients treated with rivaroxaban, 60 patients with dabigatran, and 54 patients with apixaban. The proportion of patients treated with reduced NOAC doses adequately to the guidelines was 29%, 100%, and 33% for rivaroxaban, dabigatran, and apixaban, respectively. Inappropriate low doses of NOACs were used in 71% of subjects on rivaroxaban and 67% on apixaban.
CONCLUSIONS
In patients with AF undergoing PCI, NOACs are definitely preferred over vitamin-K antagonists (VKAs) in TAT/DAT, and an aggressive antithrombotic strategy with TAT is frequently chosen even if DAT is permissible by the guidelines. Label adherence of using reduced NOAC dose during combination therapy is not satisfactory for apixaban and rivaroxaban and probably results from too cautious an approach to the known indications for reduced therapy. The study is registered in the database Clinical Trials-NCT04419012.
背景
尽管对于接受经皮冠状动脉介入治疗（PCI）的心房颤动（AF）患者推荐使用三联抗栓治疗（TAT），但指南允许选择双联抗栓治疗（DAT）。本研究评估了10个心脏病科对接受PCI的AF患者进行抗栓治疗的日常实践及其与现行指南的一致性。
方法
本分析纳入了前瞻性观察性注册研究（波兰心房颤动-POL-AF）中接受PCI的AF患者的医疗数据[择期或因急性冠状动脉综合征（ACS）]。
结果
在纳入的3999例连续受试者中，对359例接受PCI的患者进行了最终分析：148例因ACS接受紧急PCI，211例接受择期PCI。ACS组80例患者和择期PCI组120例患者接受了TAT治疗，尽管指南也允许使用DAT。在作为联合治疗一部分接受口服抗凝剂治疗的316例患者中，275例使用非维生素K拮抗剂口服抗凝剂（NOAC）。在接受利伐沙班治疗的74例患者、达比加群治疗的60例患者和阿哌沙班治疗的54例患者中使用了降低剂量的NOAC。根据指南，利伐沙班、达比加群和阿哌沙班使用降低剂量NOAC进行充分治疗的患者比例分别为29%、100%和33%。71%接受利伐沙班治疗的受试者和67%接受阿哌沙班治疗的受试者使用了不适当的低剂量NOAC。
结论
在接受PCI的AF患者中，在TAT/DAT中，NOAC绝对优于维生素K拮抗剂（VKA），即使指南允许使用DAT，仍经常选择积极的TAT抗栓策略。阿哌沙班和利伐沙班在联合治疗期间使用降低剂量NOAC的标签依从性不令人满意，这可能是由于对已知的降低治疗指征采取了过于谨慎的方法。该研究已在临床试验数据库Clinical Trials-NCT04419012中注册。
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