Kulkarni Namrata, Taur Santosh, Kaur Jaspreet, Akolekar Ravishankar, Es Swetha
Department of Medical Affairs, Pfizer Ltd., Mumbai, IND.
Cureus. 2023 Feb 20;15(2):e35220. doi: 10.7759/cureus.35220. eCollection 2023 Feb.
The management of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) requires appropriate antithrombotic regimens for stroke prevention and in-stent thrombosis. Current practice recommendations are largely based on consensus options as there is limited evidence from randomized clinical trials. Hence, by surveying a group of cardiologists across India, we sought to better understand the current practice patterns of using oral anticoagulants (vitamin K antagonist, VKA or non-vitamin K antagonist oral anticoagulant, NOAC) and antiplatelet therapy in those patients in India.
A cross-sectional questionnaire-based survey was conducted across India to better understand the clinical practices in AF management.
A total of 151 cardiologists participated in this survey. The most commonly prescribed combination therapy in patients with AF and ACS/undergoing PCI was triple therapy (NOAC + dual antiplatelet [aspirin and P2Y12 inhibitor]) (54.30%) followed by NOAC + single antiplatelet (33.11%). Only 11.26% of cardiologists prescribed VKA + dual antiplatelet therapy. Among anticoagulants, cardiologists prescribed NOACs to 66.11% of patients and VKAs to 25.54% of patients. Among P2Y12 inhibitors, ticagrelor (50.99%) and clopidogrel (47.02%) were the most preferred medication. The physician reported patient adherence rates to NOACs were higher compared to VKAs. Around 41.06% of cardiologists reportedly changed antiplatelet therapy for patients from dual antiplatelet to single antiplatelet therapy in three months; 36.42%, in one month; and 19.21% in six months after PCI. Around 61.59% of cardiologists stopped prescribing antiplatelet therapy for patients by one year.
Our survey demonstrated that the majority of cardiologists used triple therapy (NOAC + dual antiplatelet), followed by NOAC + single antiplatelet for managing patients with AF and ACS or undergoing PCI in line with the available guidelines.
心房颤动（AF）合并急性冠状动脉综合征（ACS）或接受经皮冠状动脉介入治疗（PCI）的患者管理需要适当的抗血栓治疗方案以预防中风和支架内血栓形成。由于随机临床试验证据有限，目前的实践建议主要基于共识意见。因此，通过对印度各地的一组心脏病专家进行调查，我们试图更好地了解印度这些患者使用口服抗凝剂（维生素K拮抗剂、VKA或非维生素K拮抗剂口服抗凝剂、NOAC）和抗血小板治疗的当前实践模式。
在印度各地进行了一项基于问卷的横断面调查，以更好地了解房颤管理中的临床实践。
共有151名心脏病专家参与了这项调查。房颤合并ACS/接受PCI患者中最常用的联合治疗是三联疗法（NOAC+双联抗血小板[阿司匹林和P2Y12抑制剂]）（54.30%），其次是NOAC+单联抗血小板（33.11%）。只有11.26%的心脏病专家开具VKA+双联抗血小板治疗。在抗凝剂方面，心脏病专家为66.11%的患者开具了NOAC，为25.54%的患者开具了VKA。在P2Y12抑制剂中，替格瑞洛（50.99%）和氯吡格雷（47.02%）是最常用的药物。医生报告称，患者对NOAC的依从率高于VKA。据报道，约41.06%的心脏病专家在PCI后三个月将患者的抗血小板治疗从双联抗血小板改为单联抗血小板治疗；36.42%在一个月内；19.21%在六个月内。约61.59%的心脏病专家在一年后停止为患者开具抗血小板治疗。
我们的调查表明，大多数心脏病专家使用三联疗法（NOAC+双联抗血小板），其次是NOAC+单联抗血小板，以管理房颤合并ACS或接受PCI的患者，这与现有指南一致。
