title: Use of Dual Antiplatelet Therapy and Patient Outcomes in Those Undergoing Percutaneous Coronary Intervention: The ROCKET AF Trial.
abstract: The authors assessed the use of dual antiplatelet therapy (DAPT) and outcomes in patients undergoing percutaneous coronary intervention (PCI) during the ROCKET AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation).
  
  
  
  The frequency, patterns, and outcomes when adding DAPT to non-vitamin K antagonist oral anticoagulants in the setting of PCI in patients with AF are largely unknown.
  
  
  
  The study population included all patients in the treatment group of the ROCKET AF trial divided by the receipt of PCI during follow-up. Clinical characteristics, PCI frequency, and rates of DAPT were reported. Clinical outcomes were adjudicated independently as part of the trial.
  
  
  
  Among 14,171 patients, 153 (1.1%) underwent PCI during a median 806 days of follow-up. Patients treated with rivaroxaban were significantly less likely to undergo PCI compared with warfarin-treated patients (61 vs. 92; p = 0.01). Study drug was continued during PCI in 81% of patients. Long-term DAPT (≥30 days) was used in 37% and single antiplatelet therapy in 34%. A small number switched from DAPT to monotherapy within 30 days of PCI (n = 19 [12.3%]) and 15% of patients received no antiplatelet therapy after PCI. Rates of stroke/systemic embolism and major bleeding events were high in post-PCI patients (4.5/100 patient-years and 10.2/100 patient-years) in both treatment groups.
  
  
  
  In patients with AF at moderate to high risk for stroke, PCI occurred in <1% per year. DAPT was used in a variable manner, with the majority of patients remaining on study drug after PCI. Rates of both thrombotic and bleeding events were high after PCI, highlighting the need for studies to determine the optimal antithrombotic therapy.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina. Electronic address: matthew.sherwood@dm.duke.edu.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Sherwood
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Derek D
authors.initials: DD
authors.lastname: Cyr
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Duke Heart Center, Duke University School of Medicine, Durham, North Carolina.
authors.forename: W Schuyler
authors.initials: WS
authors.lastname: Jones
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Becker
authors.affiliation: Bayer HealthCare Pharmaceuticals, Parsippany, New Jersey.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Berkowitz
authors.affiliation: Duke Heart Center, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Washam
authors.affiliation: Hospital of the University of Münster, Münster, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.affiliation: University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Halperin
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia.
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
authors.affiliation: Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Singer
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Duke Heart Center, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.affiliation: Janssen Pharmaceutical Research and Development, Raritan, New Jersey.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Nessel
authors.affiliation: Department of Medicine, Stanford University, Stanford, California.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Duke Heart Center, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D004311:Double-Blind Method; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D065427:Factor Xa Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012307:Risk Factors; D000069552:Rivaroxaban / Q000008:administration & dosage* / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K; D000069552:Rivaroxaban
keywords: anticoagulants; coronary disease; direct-acting oral anticoagulants; fibrillation; percutaneous coronary intervention