title: Anticoagulant and antiplatelet therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention.
abstract: The prevalence, intensity, safety, and efficacy of oral anticoagulation (OAC) in addition to dual antiplatelet therapy (DAPT) in "real-world" patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) have not yet been fully evaluated. In the Coronary REvascularization Demonstrating Outcome Study in Kyoto registry cohort-2, a total of 1,057 patients with AF (8.3%) were identified among 12,716 patients undergoing first PCI. Cumulative 5-year incidence of stroke was higher in patients with AF than in no-AF patients (12.8% vs 5.8%, p <0.0001). Although most patients with AF had CHADS2 score ≥2 (75.2%), only 506 patients (47.9%) received OAC with warfarin at hospital discharge. Cumulative 5-year incidence of stroke in the OAC group was not different from that in the no-OAC group (13.8% vs 11.8%, p = 0.49). Time in therapeutic range (TTR) was only 52.6% with an international normalized ratio of 1.6 to 2.6, and only 154 of 409 patients (37.7%) with international normalized ratio data had TTR ≥65%. Cumulative 5-year incidence of stroke in patients with TTR ≥65% was markedly lower than that in patients with TTR <65% (6.9% vs 15.1%, p = 0.01). In a 4-month landmark analysis in the OAC group, there was a trend for higher cumulative incidences of stroke and major bleeding in the on-DAPT (n = 286) than in the off-DAPT (n = 173) groups (15.1% vs 6.7%, p = 0.052 and 14.7% vs 8.7%, p = 0.10, respectively). In conclusion, OAC was underused and its intensity was mostly suboptimal in real-world patients with AF undergoing PCI, which lead to inadequate stroke prevention. Long-term DAPT in patients receiving OAC did not reduce stroke incidence.
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Goto
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Nakai
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: shizuta@kuhp.kyoto-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shizuta
authors.affiliation: Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Natsuaki
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Yahata
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Ota
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Koh
authors.initials: K
authors.lastname: Ono
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Takeru
authors.initials: T
authors.lastname: Makiyama
authors.affiliation: Division of Cardiology, Tenri Hospital, Tenri, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.affiliation: Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.affiliation: Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Takatsu
authors.affiliation: Division of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Division of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Takizawa
authors.affiliation: Division of Cardiology, Osaka Red Cross Hospital, Osaka, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Inada
authors.affiliation: Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Doi
authors.affiliation: Division of Cardiology, Cardiovascular Center, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Nohara
authors.affiliation: Division of Cardiology, Kishiwada City Hospital, Kishiwada, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Matsuda
authors.affiliation: Division of Cardiology, Koto Memorial Hospital, Higashioumi, Japan.
authors.forename: Teruki
authors.initials: T
authors.lastname: Takeda
authors.affiliation: Division of Cardiology, Maizuru Kyosai Hospital, Maizuru, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kato
authors.affiliation: Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Shirotani
authors.affiliation: Division of Cardiology, Nishi-Kobe Medical Center, Kobe, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Eizawa
authors.affiliation: Division of Cardiology, Kansai Electric Power Hospital, Osaka, Japan.
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Division of Cardiology, University of Fukui Hospital, Fukui, Japan.
authors.forename: Jong-Dae
authors.initials: JD
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Department of Cardiovascular and Respiratory, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Horie
authors.affiliation: Division of Cardiology, Shimabara Hospital, Kyoto, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Division of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Miki
authors.affiliation: Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aoyama
authors.affiliation: Division of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Suwa
authors.affiliation: Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hamasaki
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
authors.affiliation: Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Nobuyoshi
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kita
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000628:therapy*; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012042:Registries; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors