title: Effects of Triple Therapy in Patients With Non-Valvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention Regarding Thromboembolic Risk Stratification.
abstract: BACKGROUND
  The effects of dual antiplatelet therapy (DAPT) and triple therapy (TT: DAPT plus oral anticoagulation) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) regarding to CHA2DS2-VASc score remain undefined.We compare the effect of TT vs. DAPT in this setting regarding the CHA2DS2-VASc score.
  
  
  RESULTS
  In a prospective multicenter registry, 585 patients (75.2% male, 73.2 ± 8.2 years) with AF undergoing PCI were followed up during 1 year. Of them, 157 (26.8%) had a CHA2DS2-VASc=1, and 428 (73.2%) had a CHA2DS2-VASc ≥2. TT was prescribed in 51.6% with CHA2DS2-VASc=1 and in 55.5% with CHA2DS2-VASc ≥ 2. Patients with CHA2DS2-VASc=1 receiving TT had a similar thromboembolism rate to those on DAPT (1.2% vs. 1.3%, P=0.73), but more total (19.5% vs. 6.9%, P=0.01) and a tendency to more major (4.9% vs. 0%, P=0.06) bleeding. However, patients with CHA2DS2-VASc ≥ 2 receiving TT had a lower thromboembolism rate (1.7% vs. 5.3%, P=0.03) and a trend towards more bleeds (21.8% vs. 15.6%, P=0.06), with an excess of major bleeding (8.4% vs. 3.1%, P=0.01). Rates of major adverse cardiac events (MACE) in both CHA2DS2-VASc subgroups were similar, irrespective of treatment. In a Cox multivariate analysis, TT was associated to major bleeding, but not with MACE.
  
  
  CONCLUSIONS
  In patients with AF and CHA2DS2-VASc=1 undergoing PCI, the use of TT involves a high risk of bleeding without a significant benefit in preventing thromboembolism.
authors.affiliation: Cardiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona.
authors.forename: Antonia
authors.initials: A
authors.lastname: Sambola
authors.forename: Maria
authors.initials: M
authors.lastname: Mutuberría
authors.forename: Bruno
authors.initials: B
authors.lastname: García Del Blanco
authors.forename: Albert
authors.initials: A
authors.lastname: Alonso
authors.forename: José A
authors.initials: JA
authors.lastname: Barrabés
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.forename: Javier
authors.initials: J
authors.lastname: Zueco
authors.forename: Oriol
authors.initials: O
authors.lastname: Rodríguez-Leor
authors.forename: Eduard
authors.initials: E
authors.lastname: Bosch
authors.forename: Pilar
authors.initials: P
authors.lastname: Tornos
authors.forename: David
authors.initials: D
authors.lastname: García-Dorado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors