Antithrombotic treatment beyond 1 year after percutaneous coronary intervention in patients with atrial fibrillation

Thomas Jensen; Pernille Gro Thrane; Kevin Kris Warnakula Olesen; Morten Würtz; Martin Bødtker Mortensen; Christine Gyldenkerne; Troels Thim; Bjarne Linde Nørgaard; Jesper Møller Jensen; Steen Dalby Kristensen; Jens Cosedis Nielsen; John W Eikelboom; Michael Maeng

doi:10.1093/ehjcvp/pvac058

Antithrombotic treatment beyond 1 year after percutaneous coronary intervention in patients with atrial fibrillation

Thomas Jensen, Pernille Gro Thrane, Kevin Kris Warnakula Olesen, Morten Würtz, Martin Bødtker Mortensen, Christine Gyldenkerne, Troels Thim, Bjarne Linde Nørgaard, Jesper Møller Jensen, Steen Dalby Kristensen, Jens Cosedis Nielsen, John W Eikelboom, Michael Maeng^*

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Aims Beyond 1 year after percutaneous coronary intervention (PCI), guidelines recommend anticoagulant monotherapy in patients with atrial fibrillation (AF) rather than dual therapy with an anticoagulant and an antiplatelet drug. The risks and benefits of this strategy, however, remain uncertain. We examined hospitalization for bleeding and ischaemic risk beyond 1 year after PCI in patients with AF treated with monotherapy vs. dual therapy. Furthermore, among patients treated with monotherapy, we compared direct oral anticoagulant (DOAC) therapy and vitamin K antagonist (VKA) therapy. Methods and results We included all patients with AF undergoing first-time PCI between 2003 and 2017 from the Western Denmark Heart Registry and followed them for up to 4 years. Follow-up started 15 months after PCI to enable assessment of medical treatment after 12 months. Using a Cox regression model, we computed weighted hazard ratios (HR _w) of hospitalization for bleeding and major adverse cardiac events (MACEs). Analyses comparing monotherapy vs. dual therapy included 3331 patients, and analyses comparing DOAC vs. VKA monotherapy included 1275 patients. Risks of hospitalization for bleeding [HR _w 0.90, 95% confidence interval (CI) 0.75–1.09] and MACE (HR _w 1.04, 95% CI 0.90–1.19) were similar with monotherapy and dual therapy. Similarly, risks of hospitalization for bleeding (HR _w 1.27, 95% CI 0.84–1.92) and MACE (HR _w 1.15, 95% CI 0.87–1.50) were equal with DOAC and VKA monotherapy. Conclusion Our results support long-term OAC monotherapy beyond 1 year after PCI in patients with atrial fibrillation and suggest that DOAC monotherapy is as safe and effective as VKA monotherapy.

Original language	English
Article number	208-219
Journal	European heart journal - Cardiovascular pharmacotherapy
Volume	9
Issue	3
Pages (from-to)	208-219
Number of pages	12
ISSN	2055-6837
DOIs	https://doi.org/10.1093/ehjcvp/pvac058
Publication status	Published - Apr 2023

Keywords

Atrial fibrillation
Bleeding
Cohort study
Percutaneous
Thromboembolism
coronary intervention

Access to Document

10.1093/ehjcvp/pvac058

Cite this

Jensen, T., Thrane, P. G., Olesen, K. K. W., Würtz, M., Mortensen, M. B., Gyldenkerne, C., Thim, T., Nørgaard, B. L., Jensen, J. M., Kristensen, S. D., Nielsen, J. C., Eikelboom, J. W., & Maeng, M. (2023). Antithrombotic treatment beyond 1 year after percutaneous coronary intervention in patients with atrial fibrillation. European heart journal - Cardiovascular pharmacotherapy, 9(3), 208-219. Article 208-219. https://doi.org/10.1093/ehjcvp/pvac058

@article{9eb5a09e316742a4abfa095dd6fb12e6,

title = "Antithrombotic treatment beyond 1 year after percutaneous coronary intervention in patients with atrial fibrillation",

abstract = "Aims Beyond 1 year after percutaneous coronary intervention (PCI), guidelines recommend anticoagulant monotherapy in patients with atrial fibrillation (AF) rather than dual therapy with an anticoagulant and an antiplatelet drug. The risks and benefits of this strategy, however, remain uncertain. We examined hospitalization for bleeding and ischaemic risk beyond 1 year after PCI in patients with AF treated with monotherapy vs. dual therapy. Furthermore, among patients treated with monotherapy, we compared direct oral anticoagulant (DOAC) therapy and vitamin K antagonist (VKA) therapy. Methods and results We included all patients with AF undergoing first-time PCI between 2003 and 2017 from the Western Denmark Heart Registry and followed them for up to 4 years. Follow-up started 15 months after PCI to enable assessment of medical treatment after 12 months. Using a Cox regression model, we computed weighted hazard ratios (HR w) of hospitalization for bleeding and major adverse cardiac events (MACEs). Analyses comparing monotherapy vs. dual therapy included 3331 patients, and analyses comparing DOAC vs. VKA monotherapy included 1275 patients. Risks of hospitalization for bleeding [HR w 0.90, 95% confidence interval (CI) 0.75–1.09] and MACE (HR w 1.04, 95% CI 0.90–1.19) were similar with monotherapy and dual therapy. Similarly, risks of hospitalization for bleeding (HR w 1.27, 95% CI 0.84–1.92) and MACE (HR w 1.15, 95% CI 0.87–1.50) were equal with DOAC and VKA monotherapy. Conclusion Our results support long-term OAC monotherapy beyond 1 year after PCI in patients with atrial fibrillation and suggest that DOAC monotherapy is as safe and effective as VKA monotherapy.",

keywords = "Atrial fibrillation, Bleeding, Cohort study, Percutaneous, Thromboembolism, coronary intervention",

author = "Thomas Jensen and Thrane, {Pernille Gro} and Olesen, {Kevin Kris Warnakula} and Morten W{\"u}rtz and Mortensen, {Martin B{\o}dtker} and Christine Gyldenkerne and Troels Thim and N{\o}rgaard, {Bjarne Linde} and Jensen, {Jesper M{\o}ller} and Kristensen, {Steen Dalby} and Nielsen, {Jens Cosedis} and Eikelboom, {John W} and Michael Maeng",

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2023",

month = apr,

doi = "10.1093/ehjcvp/pvac058",

language = "English",

volume = "9",

pages = "208--219",

journal = "European heart journal - Cardiovascular pharmacotherapy",

issn = "2055-6837",

publisher = "Oxford University Press",

number = "3",

}

Jensen, T , Thrane, PG , Olesen, KKW , Würtz, M , Mortensen, MB , Gyldenkerne, C , Thim, T , Nørgaard, BL, Jensen, JM, Kristensen, SD , Nielsen, JC, Eikelboom, JW & Maeng, M 2023, 'Antithrombotic treatment beyond 1 year after percutaneous coronary intervention in patients with atrial fibrillation', European heart journal - Cardiovascular pharmacotherapy, vol. 9, no. 3, 208-219, pp. 208-219. https://doi.org/10.1093/ehjcvp/pvac058

Antithrombotic treatment beyond 1 year after percutaneous coronary intervention in patients with atrial fibrillation. / Jensen, Thomas ; Thrane, Pernille Gro ; Olesen, Kevin Kris Warnakula et al.
In: European heart journal - Cardiovascular pharmacotherapy, Vol. 9, No. 3, 208-219, 04.2023, p. 208-219.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Antithrombotic treatment beyond 1 year after percutaneous coronary intervention in patients with atrial fibrillation

AU - Jensen, Thomas

AU - Thrane, Pernille Gro

AU - Olesen, Kevin Kris Warnakula

AU - Würtz, Morten

AU - Mortensen, Martin Bødtker

AU - Gyldenkerne, Christine

AU - Thim, Troels

AU - Nørgaard, Bjarne Linde

AU - Jensen, Jesper Møller

AU - Kristensen, Steen Dalby

AU - Nielsen, Jens Cosedis

AU - Eikelboom, John W

AU - Maeng, Michael

N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2023/4

Y1 - 2023/4

N2 - Aims Beyond 1 year after percutaneous coronary intervention (PCI), guidelines recommend anticoagulant monotherapy in patients with atrial fibrillation (AF) rather than dual therapy with an anticoagulant and an antiplatelet drug. The risks and benefits of this strategy, however, remain uncertain. We examined hospitalization for bleeding and ischaemic risk beyond 1 year after PCI in patients with AF treated with monotherapy vs. dual therapy. Furthermore, among patients treated with monotherapy, we compared direct oral anticoagulant (DOAC) therapy and vitamin K antagonist (VKA) therapy. Methods and results We included all patients with AF undergoing first-time PCI between 2003 and 2017 from the Western Denmark Heart Registry and followed them for up to 4 years. Follow-up started 15 months after PCI to enable assessment of medical treatment after 12 months. Using a Cox regression model, we computed weighted hazard ratios (HR w) of hospitalization for bleeding and major adverse cardiac events (MACEs). Analyses comparing monotherapy vs. dual therapy included 3331 patients, and analyses comparing DOAC vs. VKA monotherapy included 1275 patients. Risks of hospitalization for bleeding [HR w 0.90, 95% confidence interval (CI) 0.75–1.09] and MACE (HR w 1.04, 95% CI 0.90–1.19) were similar with monotherapy and dual therapy. Similarly, risks of hospitalization for bleeding (HR w 1.27, 95% CI 0.84–1.92) and MACE (HR w 1.15, 95% CI 0.87–1.50) were equal with DOAC and VKA monotherapy. Conclusion Our results support long-term OAC monotherapy beyond 1 year after PCI in patients with atrial fibrillation and suggest that DOAC monotherapy is as safe and effective as VKA monotherapy.

AB - Aims Beyond 1 year after percutaneous coronary intervention (PCI), guidelines recommend anticoagulant monotherapy in patients with atrial fibrillation (AF) rather than dual therapy with an anticoagulant and an antiplatelet drug. The risks and benefits of this strategy, however, remain uncertain. We examined hospitalization for bleeding and ischaemic risk beyond 1 year after PCI in patients with AF treated with monotherapy vs. dual therapy. Furthermore, among patients treated with monotherapy, we compared direct oral anticoagulant (DOAC) therapy and vitamin K antagonist (VKA) therapy. Methods and results We included all patients with AF undergoing first-time PCI between 2003 and 2017 from the Western Denmark Heart Registry and followed them for up to 4 years. Follow-up started 15 months after PCI to enable assessment of medical treatment after 12 months. Using a Cox regression model, we computed weighted hazard ratios (HR w) of hospitalization for bleeding and major adverse cardiac events (MACEs). Analyses comparing monotherapy vs. dual therapy included 3331 patients, and analyses comparing DOAC vs. VKA monotherapy included 1275 patients. Risks of hospitalization for bleeding [HR w 0.90, 95% confidence interval (CI) 0.75–1.09] and MACE (HR w 1.04, 95% CI 0.90–1.19) were similar with monotherapy and dual therapy. Similarly, risks of hospitalization for bleeding (HR w 1.27, 95% CI 0.84–1.92) and MACE (HR w 1.15, 95% CI 0.87–1.50) were equal with DOAC and VKA monotherapy. Conclusion Our results support long-term OAC monotherapy beyond 1 year after PCI in patients with atrial fibrillation and suggest that DOAC monotherapy is as safe and effective as VKA monotherapy.

KW - Atrial fibrillation

KW - Bleeding

KW - Cohort study

KW - Percutaneous

KW - Thromboembolism

KW - coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85159050997&partnerID=8YFLogxK

U2 - 10.1093/ehjcvp/pvac058

DO - 10.1093/ehjcvp/pvac058

M3 - Journal article

C2 - 36269306

SN - 2055-6837

VL - 9

SP - 208

EP - 219

JO - European heart journal - Cardiovascular pharmacotherapy

JF - European heart journal - Cardiovascular pharmacotherapy

IS - 3

M1 - 208-219

ER -

Antithrombotic treatment beyond 1 year after percutaneous coronary intervention in patients with atrial fibrillation

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this