title: Comparison of different antithrombotic regimens for patients with atrial fibrillation undergoing drug-eluting stent implantation.
abstract: BACKGROUND
  The optimal antithrombotic strategy for patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation is unknown.
  
  
  RESULTS
  The 622 consecutive AF patients undergoing DES implantation were prospectively enrolled. Among them, 142 patients (TT group) continued triple antithrombotic therapy comprising aspirin, clopidogrel and warfarin after discharge; 355 patients (DT group) had dual antiplatelet therapy; 125 patients (WS group) were discharged with warfarin and a single antiplatelet agent. Target INR was set as 1.8-2.5 and was regularly monitored after discharge. The TT group had a significant reduction in stroke and major adverse cardiac and cerebral events (MACCE) (8.8% vs 20.1% vs 14.9%, P=0.010) as compared with either the DT or WS group. In the Cox regression analysis, administration with warfarin (hazard ratio (HR) 0.49; 95% confidence interval (CI) 0.31-0.77; P=0.002) and baseline CHADS(2) score >or=2 (HR 2.09; 95%CI 1.27-3.45; P=0.004) were independent predictors of MACCE. Importantly, the incidence of major bleeding was comparable among 3 groups (2.9% vs 1.8% vs 2.5%, P=0.725), although the overall bleeding rate was increased in the TT group. Kaplan-Meier analysis indicated that the TT group was associated with the best net clinical outcome.
  
  
  CONCLUSIONS
  The cardiovascular benefits of triple antithrombotic therapy were confirmed by reducing the MACCE rate, and its major bleeding risk might be acceptable if the INR is closely monitored.
authors.affiliation: Department of Cardiology, An Zhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Gao
authors.forename: Yu Jie
authors.initials: YJ
authors.lastname: Zhou
authors.forename: Zhi Jian
authors.initials: ZJ
authors.lastname: Wang
authors.forename: Hua
authors.initials: H
authors.lastname: Shen
authors.forename: Xiao Li
authors.initials: XL
authors.lastname: Liu
authors.forename: Bin
authors.initials: B
authors.lastname: Nie
authors.forename: Zhen Xian
authors.initials: ZX
authors.lastname: Yan
authors.forename: Shi Wei
authors.initials: SW
authors.lastname: Yang
authors.forename: De An
authors.initials: de A
authors.lastname: Jia
authors.forename: Miao
authors.initials: M
authors.lastname: Yu
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000628:therapy*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin