title: Long-term safety and efficacy of dual therapy with oral anticoagulation and clopidogrel in patients with atrial fibrillation treated with drug-eluting stents.
abstract: BACKGROUND
  The optimal antithrombotic treatment for patients on oral anticoagulants (OAC) undergoing percutaneous coronary intervention (PCI) is controversial. We analyzed the safety and efficacy of dual therapy with OAC plus clopidogrel in atrial fibrillation (AF) patients receiving drug-eluting stents (DES).
  
  
  RESULTS
  In this retrospective analysis, all AF patients treated with dual therapy were retrospectively identified. Efficacy endpoints included cardiac death, myocardial infarction (MI), stent thrombosis (ST) and cerebrovascular stroke at follow-up, while safety was assessed by bleeding events defined by the Bleeding Academic Research Consortium (BARC). Between January 2008 and August 2010, 221 patients with high-risk AF received a DES and a dual therapy with OAC and clopidogrel. At a mean follow-up of 19 months, bleeding complications occurred in 22 patients (10 %), more than half of them (n = 12) were related to the index PCI. We observed 11 cardiac deaths (4.9 %), 9 MIs (4.1 %), 3 definite (1.4 %) and no probable ST at follow-up. All definite ST occurred after cessation of clopidogrel at 8, 22, and 30 months after PCI in patients not adequately anticoagulated. Eight patients (3.6 %) had an ischemic stroke, five of which after temporary or permanent cessation of OAC.
  
  
  CONCLUSIONS
  The data generated from this large single-center experience in AF patients treated with DES revealed that dual therapy with OAC plus clopidogrel for 6-12 months followed by monotherapy with OAC appears both safe and effective at long-term follow-up. However, after clopidogrel cessation, maintaining therapeutic anticoagulation with an INR >2 is essential to prevent both thrombotic and embolic events.
authors.affiliation: Department of Cardiology, Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, 23795, Hamburg, Germany.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Seivani
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: Volker
authors.initials: V
authors.lastname: Geist
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Dmitriy S
authors.initials: DS
authors.lastname: Sulimov
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Mawardy
authors.forename: Ralph
authors.initials: R
authors.lastname: Toelg
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013927:Thrombosis / Q000517:prevention & control; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine