title: Triple antithrombotic therapy versus dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation.
abstract: BACKGROUND
  The optimal antithrombotic regimen in patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation for complex coronary artery disease is unclear. We compared the net clinical outcomes of triple antithrombotic therapy (TAT; aspirin, thienopyridine, and warfarin) and dual antiplatelet therapy (DAPT; aspirin and thienopyridine) in AF patients who had undergone DES implantation.
  
  
  METHODS
  A total of 367 patients were enrolled and analyzed retrospectively; 131 patients (35.7%) received TAT and 236 patients (64.3%) received DAPT. DAPT and warfarin were maintained for a minimum of 12 and 24 months, respectively. The primary endpoint was the 2-year net clinical outcomes, a composite of major bleeding and major adverse cardiac and cerebral events (MACCE). Propensity score-matching analysis was carried out in 99 patient pairs.
  
  
  RESULTS
  The 2-year net clinical outcomes of the TAT group were worse than those of the DAPT group (34.3 vs. 21.1%, P=0.006), which was mainly due to the higher incidence of major bleeding (16.7 vs. 4.6%, P<0.001), without any significant increase in MACCE (22.1 vs. 17.7%, P=0.313). In the multivariate analysis, TAT was an independent predictor of worse net clinical outcomes (odds ratio 1.63, 95% confidence interval 1.06-2.50) and major bleeding (odds ratio 3.54, 95% confidence interval 1.65-7.58). After propensity score matching, the TAT group still had worse net clinical outcomes and a higher incidence of major bleeding compared with the DAPT group.
  
  
  CONCLUSIONS
  In AF patients undergoing DES implantation, prolonged administration of TAT may be harmful due to the substantial increase in the risk for major bleeding without any reduction in MACCE.
authors.affiliation: aCardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul bSejong General Hospital, Sejong Heart Institute, Kyunggi-do, Republic of Korea.
authors.forename: Dong Oh
authors.initials: DO
authors.lastname: Kang
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Yu
authors.forename: Hee Dong
authors.initials: HD
authors.lastname: Kim
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Cho
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Joo
authors.forename: Rak Kyong
authors.initials: RK
authors.lastname: Choi
authors.forename: Jin Sik
authors.initials: JS
authors.lastname: Park
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Je Sang
authors.initials: JS
authors.lastname: Kim
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Park
authors.forename: Soon Jun
authors.initials: SJ
authors.lastname: Hong
authors.forename: Do-Sun
authors.initials: DS
authors.lastname: Lim
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002561:Cerebrovascular Disorders / Q000209:etiology; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D014859:Warfarin; D001241:Aspirin