title: Balancing between bleeding and thromboembolism after percutaneous coronary intervention in patients with atrial fibrillation. Could triple anticoagulant therapy be a solution?
abstract: BACKGROUND
  Atrial fibrillation (AF) has nowadays become a common disease as it comes along with medical procedures propagation in the ageing population with coexistent diseases. Hence a need for use of combined anticoagulant and antithrombotic therapy has arisen. According to the 2010 ESC guidelines on myocardial revascularization, short-term triple antithrombotic therapy after percutaneous coronary intervention (PCI) should be given if compelling indications exist.
  
  
  OBJECTIVE
  To assess bleeding and thromboembolic events depending on the antithrombotic regimen in short- and long-term follow-up in patients with AF after PCI with stent implantation.
  
  
  METHODS
  A 12-month prospective, non-randomized registry was conducted in the 3(rd) Department of Cardiology in the Upper Silesian Medical Center in Katowice from October 2008 to April 2011. One hundred and four patients in two groups - on triple therapy (TT; aspirin + clopidogrel + vitamin K antagonists (VKA; warfarin or acenocoumarol) n = 44) and on dual therapy (DT; aspirin + clopidogrel; n = 60) - were assessed 30 days and 12 months after angioplasty.
  
  
  RESULTS
  All bleeding events occurred more often in the triple anticoagulated group in 30 days (TT 20.5% vs. DT 6.7%; p = 0.03) and after 12 months (TT 38.9% vs. DT 17.2%, p = 0.09). The difference in major bleeding events was not significant after 30 days (TT 9.1% vs. DT 3.3%; p = NS) or 12 months (TT 11.1% vs. DT 6.9%; p = NS). Thromboembolic events after 30 days (DT 5.0% vs. TT 2.3%) and 12 months (TT 11.1% vs. DT 3.4%) were comparable. The percentage of deaths after 30 days (DT 1.7% vs. TT 0.0%, p = NS) increased after 12 months (DT 13.8% vs. TT 0.0%, p = 0.09).
  
  
  CONCLUSIONS
  Significantly higher risk of bleeding on TT becomes blurred by a tendency to increased mortality in patients on DT.
authors.affiliation: Cardiology Student Research Group, 3 Division of Cardiology, 3 Department of Cardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Dąbrowska
authors.affiliation: Invasive Cardiology Department, Medical University of Silesia, Katowice, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Ochała
authors.affiliation: 3 Division of Cardiology, 3 Department of Cardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Wiesław
authors.initials: W
authors.lastname: Cybulski
authors.affiliation: 3 Division of Cardiology, 3 Department of Cardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Tendera
keywords: anticoagulants; atrial fibrillation; percutaneous coronary intervention; triple therapy