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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, 2023.Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review
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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
Y1 - 2023
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 ischemic risk beyond 1 year after PCI in patients with AF treated with monotherapy versus 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 (HRw) of hospitalization for bleeding and major adverse cardiac events (MACE). Analyses comparing monotherapy versus dual therapy included 3331 patients, and analyses comparing DOAC versus VKA monotherapy included 1275 patients. Risks of hospitalization for bleeding (HRw 0.90, 95% confidence interval [CI] 0.75-1.09) and MACE (HRw 1.04, 95% CI 0.90-1.19) were similar with monotherapy and dual therapy. Similarly, risks of hospitalization for bleeding (HRw 1.27, 95% CI 0.84-1.92) and MACE (HRw 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 ischemic risk beyond 1 year after PCI in patients with AF treated with monotherapy versus 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 (HRw) of hospitalization for bleeding and major adverse cardiac events (MACE). Analyses comparing monotherapy versus dual therapy included 3331 patients, and analyses comparing DOAC versus VKA monotherapy included 1275 patients. Risks of hospitalization for bleeding (HRw 0.90, 95% confidence interval [CI] 0.75-1.09) and MACE (HRw 1.04, 95% CI 0.90-1.19) were similar with monotherapy and dual therapy. Similarly, risks of hospitalization for bleeding (HRw 1.27, 95% CI 0.84-1.92) and MACE (HRw 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.
U2 - 10.1093/ehjcvp/pvac058
DO - 10.1093/ehjcvp/pvac058
M3 - Journal article
C2 - 36269306
JO - European heart journal. Cardiovascular pharmacotherapy
JF - European heart journal. Cardiovascular pharmacotherapy
SN - 2055-6837
ER -