title: Efficacy and safety of aspirin, clopidogrel, and warfarin after coronary artery stenting in Korean patients with atrial fibrillation.
abstract: There are limited data on the optimal antithrombotic therapy for patients with atrial fibrillation (AF) who undergoing coronary stenting. We reviewed 203 patients (62.6 % men, mean age 68.3 ± 10.1 years) between 2003 and 2012, and recorded clinical and demographic characteristics of the patients. Clinical follow-up included major adverse cardiac and cerebrovascular events (MACCE) (cardiac death, myocardial infarction, target lesion revascularization, and stroke), stent thrombosis, and bleeding. The most commonly associated comorbidities were hypertension (70.4 %), diabetes mellitus (35.5 %), and congestive heart failure (26.6 %). Sixty-three percent of patients had stroke risk higher than CHADS2 score 2. At discharge, dual-antiplatelet therapy (aspirin, clopidogrel) was used in 166 patients (81.8 %; Group I), whereas 37 patients (18.2 %) were discharged with triple therapy (aspirin, clopidogrel, warfarin; Group II). The mean follow-up period was 42.0 ± 29.0 months. The mean international normalized ratio (INR) in group II was 1.83 ± 0.41. The total MACCE was 16.3 %, with stroke in 3.4 %. Compared with the group II, the incidence of MACCE (2.7 % vs 19.3 %, P = 0.012) and cardiac death (0 % vs 11.4 %, P = 0.028) were higher in the group I. Major and any bleeding, however, did not differ between the two groups. In multivariate analysis, no warfarin therapy (odds ratio 7.8, 95 % confidence interval 1.02-59.35; P = 0.048) was an independent predictor of MACCE. By Kaplan-Meier survival analysis, warfarin therapy was associated with a lower risk of MACCE (P = 0.024). In patients with AF undergoing coronary artery stenting, MACCE were reduced by warfarin therapy without increased bleeding, which might be related to tighter control with a lower INR value.
authors: Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Korea.
authors: Soon Yong
authors: SY
authors: Suh
authors: Woong Chol
authors: WC
authors: Kang
authors: Pyung Chun
authors: PC
authors: Oh
authors: Hanul
authors: H
authors: Choi
authors: Chan Il
authors: CI
authors: Moon
authors: Kyounghoon
authors: K
authors: Lee
authors: Seung Hwan
authors: SH
authors: Han
authors: Taehoon
authors: T
authors: Ahn
authors: In Suck
authors: IS
authors: Choi
authors: Eak Kyun
authors: EK
authors: Shin
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D044466:Asian People; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D001777:Blood Coagulation / Q000187:drug effects; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000208:ethnology / Q000517:prevention & control; D018572:Disease-Free Survival; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000208:ethnology / Q000517:prevention & control; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000208:ethnology / Q000517:prevention & control; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
references: J Am Coll Cardiol. 2007 Jul 24;50(4):309-15
references: 17659197
references: Curr Cardiol Rep. 2006 Sep;8(5):323-9
references: 16956446
references: Lancet. 2006 Jun 10;367(9526):1903-12
references: 16765759
references: Circ Cardiovasc Interv. 2011 Oct 1;4(5):522-34
references: 22010191
references: J Am Coll Cardiol. 2009 Jul 7;54(2):95-109
references: 19573725
references: J Am Coll Cardiol. 2008 Feb 26;51(8):818-25
references: 18294566
references: J Am Coll Cardiol. 2008 Jun 10;51(23):2220-7
references: 18534267
references: Cardiology. 2006;105(2):80-5
references: 16286733
references: Eur Heart J. 2007 Jul;28(14):1717-22
references: 17562671
references: Lancet. 2013 Mar 30;381(9872):1107-15
references: 23415013
references: Eur Heart J. 2010 Oct;31(19):2369-429
references: 20802247
references: Korean Circ J. 2011 Oct;41(10):578-82
references: 22125556
references: Heart Vessels. 2014 Jan;29(1):1-6
references: 23274578
references: Am J Cardiol. 2008 Dec 15;102(12):1618-23
references: 19064015
references: Circ J. 2007 May;71(5):761-5
references: 17457005
references: Chest. 2008 Sep;134(3):559-567
references: 18641090
references: J Am Coll Cardiol. 2006 Dec 19;48(12):2584-91
references: 17174201
references: Chest. 2006 Dec;130(6):1823-7
references: 17167003
references: Heart Vessels. 2012 Nov;27(6):568-75
references: 21909806
references: JAMA. 2007 Jan 10;297(2):159-68
references: 17148711
references: Thromb Haemost. 2009 Nov;102(5):914-5
references: 19888529
references: JAMA. 2001 May 9;285(18):2370-5
references: 11343485
references: Circ J. 2010 Apr;74(4):701-8
references: 20208381
references: EuroIntervention. 2009 Jun;5(2):277-81
references: 19527984
references: Am J Cardiol. 2012 May 15;109(10):1411-7
references: 22342850