title: Bridging therapy with low molecular weight heparin in patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation: the AFCAS study.
abstract: BACKGROUND
  Recent reports have provided evidence that bridging therapy with low-molecular-weight heparin (LMWH) may increase bleeding complications in patients with atrial fibrillation (AF) on oral anticoagulation undergoing percutaneous coronary intervention (PCI). We sought to assess mid-term bleeding and thromboembolic events in patients from the AFCAS registry discharged on triple therapy (TT).
  
  
  METHODS
  AFCAS is a multicenter, prospective registry enrolling patients with AF undergoing PCI. The primary endpoints were: 1) bleeding complications as defined by the bleeding academic research criteria (BARC); 2) a composite of cardiac and cerebrovascular events (MACCE) at 3 and 12 month follow-ups.
  
  
  RESULTS
  Altogether 663 out of 929 consecutive patients were discharged on TT, either on oral vitamin K antagonist (VKA-TT) (n=498) or bridging LMWH-TT (n=165). Patients on LMWH-TT had more often diabetes, heart failure, and hypertension compared to those on VKA-TT. The rates of major bleeding events (BARC≥3) (11.5% vs. 6.0%, p=0.03) as well as MACCE (11.5% vs. 5.0%, p=0.006) were higher in the LMWH-TT group compared to VKA-TT group at 3 months follow-up. In a Cox multivariate regression model and propensity-score matched analysis LMWH-TT increased the risk for major BARC bleeding events at 3 and 12 month follow-ups.
  
  
  CONCLUSIONS
  In this large, prospective, real-world population of patients with AF undergoing PCI patients discharged on LMWH-TT had a significantly higher risk for major bleeds in comparison to patients discharged on VKA-TT. LMWH-bridging therapy appeared harmful in this subset of patient on oral anticoagulation.
authors: Heart Center, Turku University Hospital and University of Turku, Finland. Electronic address: tuomas.kiviniemi@utu.fi.
authors: Tuomas
authors: T
authors: Kiviniemi
authors: Heart Center, Turku University Hospital and University of Turku, Finland.
authors: K E Juhani
authors: KE
authors: Airaksinen
authors: Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy.
authors: Andrea
authors: A
authors: Rubboli
authors: Department of Surgery, Oulu University Hospital, Finland.
authors: Fausto
authors: F
authors: Biancari
authors: Department of Cardiology, General Hospital University of Alicante, Spain.
authors: Josè
authors: J
authors: Valencia
authors: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, UK.
authors: Gregory Y H
authors: GY
authors: Lip
authors: Satakunta Central Hospital, Finland.
authors: Pasi P
authors: PP
authors: Karjalainen
authors: Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany.
authors: Michael
authors: M
authors: Weber
authors: Department of Medicine, Division of Cardiology, Helsinki University Hospital, Finland.
authors: Mika
authors: M
authors: Laine
authors: Department of Cardiology and Angiology, University Hospital Münster, Germany; University of Birmingham Centre for Cardiovascular Sciences, City Hospital, UK.
authors: Paulus
authors: P
authors: Kirchhof
authors: Medical Faculty, Martin Luther-University Halle, Germany; Department of Cardiology, Paracelsus Harz-Clinic Bad Suderode, Germany.
authors: Axel
authors: A
authors: Schlitt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D015607:Stents
chemical_list: D006495:Heparin, Low-Molecular-Weight
keywords: Anticoagulation; Atrial fibrillation; Bridging therapy; Coronary heart disease