Lee Chiao-Chin, Chang Chiao-Hsiang, Hung Yuan, Lin Chin-Sheng, Yang Shih-Ping, Cheng Shu-Meng, Yu Fan-Han, Lin Wei-Shiang, Lin Wen-Yu
Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Division of Cardiology, Department of Internal Medicine Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Gong Road, Section 2, Neihu 114, Taipei, Taiwan.
Thromb J. 2021 Dec 14;19(1):100. doi: 10.1186/s12959-021-00353-z.
The choice of optimal antithrombotic therapy in atrial fibrillation (AF) patients with acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) remains controversial. The aim of this longitudinal cohort study is to investigate the prescribing pattern of antithrombotic regimen in different cohorts and its subsequent impact.
Longitudinal data from the Tri-Service General Hospital-Coronary Heart Disease (TSGH-CHD) registry, between January 2016 and August 2018 was screened.
Patients with prior history of nonvalvular AF, who had ACS presentation or underwent PCI were selected, and these patients were divided into cohort 1 and cohort 2, according to the index date of antithrombotic prescription before and after the PIONEER AF-PCI study.
The primary safety endpoints were composites of major bleeding and/or clinically relevant non-major bleeding. The secondary efficacy endpoints included the occurrence of all-cause mortality, stroke/systemic embolization, nonfatal myocardial infarction (MI), and >30-days coronary revascularization.
A total of 121 patients were included into analysis (cohort 1=35; cohort 2=86). Comparing with cohort 1, the prescription rate of triple antithrombotic therapy (TAT) increased from 17.1 to 38.4%, especially the regimen with dual antiplatelet therapy (DAPT) plus low-dose non-vitamin-K dependent oral anticoagulation (NOAC). However, the prescription rate of dual antithrombotic therapy (DAT) decreased (14.3-10.5%), as well as the prescription rate of DAPT (68.6-51.2%). These changes of antithrombotic prescription across different cohorts were not associated with risk of adverse safety (HR= 0.87; 95% CI, 0.42-1.80, p=0.710) and efficacy outcomes (HR=0.96; 95% CI, 0.40-2.32, p=0.930).
Entering the NOAC era, the prescription of TAT increased alongside the decrease in DAT. As the prescription rate of DAPT without anticoagulation remained high, future efforts are mandatory to improve the implementation of guidelines and clinical practice.
对于患有急性冠状动脉综合征（ACS）或接受经皮冠状动脉介入治疗（PCI）的心房颤动（AF）患者，选择最佳抗栓治疗方案仍存在争议。这项纵向队列研究的目的是调查不同队列中抗栓方案的处方模式及其后续影响。
筛选了2016年1月至2018年8月三军总医院冠心病（TSGH-CHD）登记处的纵向数据。
选择有非瓣膜性房颤病史、出现ACS或接受PCI的患者，并根据先锋AF-PCI研究前后抗栓处方的索引日期将这些患者分为队列1和队列2。
主要安全终点是大出血和/或临床相关非大出血的复合终点。次要疗效终点包括全因死亡率、中风/全身性栓塞、非致命性心肌梗死（MI）和>30天的冠状动脉血运重建。
共有121例患者纳入分析（队列1 = 35例；队列2 = 86例）。与队列1相比，三联抗栓治疗（TAT）的处方率从17.1%增加到38.4%，尤其是双联抗血小板治疗（DAPT）加低剂量非维生素K拮抗剂口服抗凝药（NOAC）的方案。然而，双联抗栓治疗（DAT）的处方率下降（从14.3%降至10.5%），DAPT的处方率也下降（从68.6%降至51.2%）。不同队列间抗栓处方的这些变化与不良安全风险（HR = 0.87；95%CI，0.42 - 1.80，p = 0.710）和疗效结局（HR = 0.96；95%CI，0.40 - 2.32，p = 0.930）无关。
进入NOAC时代，TAT的处方率增加而DAT的处方率下降。由于无抗凝治疗的DAPT处方率仍然很高，未来必须努力改善指南的实施和临床实践。
