Dilemma of antithrombotic therapy in anticoagulated atrial fibrillation patients squeezed between thrombosis and bleeding events: a single-centre experience.
The aim of this study was to evaluate the rate of bleeding, thromboembolic complications, and the rate of stent thrombosis or restenosis in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). In this retrospective analysis, we included patients with AF who underwent PCI with stent implantation from 2003 to 2006. Combinations of aspirin, clopidogrel, and oral anticoagulation with phenprocoumon (OAC) were used for antithrombotic management. Follow-up was performed by telephone interview. Adverse events (AEs) were defined as major bleedings, stroke/transient ischaemic attack, peripheral embolism, stent thrombosis, or restenosis. One hundred and seventeen patients (85 men, mean age 72.0 +/- 8.2 years) were included in the study. Fifty-five patients (47%) received drug-eluting stents, 62 patients (53%) bare-metal stents. After coronary intervention, 53 patients (45.3%) received a combination of aspirin, clopidogrel, and OAC, 64 (54.7%) patients received other antithrombotic regimens. Eighteen patients died during follow-up, 11 patients presumably of cardiac and 7 patients of non-cardiac causes. In total, 26 AEs occurred in 24 of 113 patients (21.2%) during follow-up: 13 major bleedings, 6 cardioembolic complications, 3 stent thromboses, and 4 restenoses. The present study demonstrates an 11.5% rate of major bleedings, a 5.3% rate of thromboembolic events, and a 2.7% rate of stent thromboses in the high-risk group of patients with AF and coronary stent implantation. The decision on different antithrombotic treatment regimens needs to be based on the patients' individual risk until further prospective studies have evaluated the risk-benefit profile of a standardized approach of triple therapy in this high-risk patient group.
Halbfass
Philipp
P
Heart Center Bogenhausen, Department of Cardiology, Städtisches Klinikum München, Englschalkinger Strasse 77, 81925 Munich, Germany. halbfass@web.de
Janko
Sabine
S
Dorwarth
Uwe
U
Riess
Gotthard
G
Antoni
Diethmar
D
Hoffmann
Ellen
E
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000401:mortality* / Q000517:prevention & control*; D015897:Comorbidity; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D019106:Postoperative Hemorrhage / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate
D000925:Anticoagulants; D005343:Fibrinolytic Agents