title: Triple anticoagulation therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention - real life assessment.
abstract: BACKGROUND
  Triple anticoagulation therapy (TT), comprising dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC), is essential in atrial fibrillation (AF) patients after percutaneous coronary intervention (PCI), but it increases the bleeding risk.
  
  
  OBJECTIVE
  To assess TT models, in- and out-hospital bleeding and thromboembolic complications, and TT alterations.
  
  
  METHODS
  During 12 months, consecutive AF post-PCI patients were scheduled for TT. Alterations in TT and thromboembolic events (death, myocardial infarction, ischemic stroke, in-stent thrombosis, peripheral embolization) were recorded. Major, non-major and minor bleeding episodes were assessed.
  
  
  RESULTS
  One hundred and thirty-six out of 3171 patients, aged 73.0 ±8.4 years (90 male), were included. Intra-hospitally, thrombotic events occurred in 9 (6.6%), while bleeding events occurred in 71 (52.2%) patients. Access-site hematoma and blood transfusions during in-hospital stay predisposed physicians to heparin administration as part of TT on discharge (p= 0.018 andp= 0.033 respectively). Eventually, DAPT plus warfarin or plus novel oral anticoagulant (NOAC) or plus low molecular weight heparin was prescribed in 72 (52.9%), 53 (39%), and 11 (8.1%) patients, respectively. HAS-BLED and CHA2DS2-VASc scores were similar between subgroups (p= 0.63 andp= 0.64 respectively). During 10.2 ±4.2 months of follow-up, 11 (8.1%) deaths, and 9 (6.6%) non-fatal thromboembolic events occurred. Bleeding events occurred in 45 (34.6%) patients, including 14 (10.3%) major. TT was the only factor associated with increased risk of major bleeding (18.6% vs. 4.2%,p= 0.008). Early termination of any TT component, which concerned 59 (45.4%) patients, did not increase the risk of thromboembolic events (p= 0.89).
  
  
  CONCLUSIONS
  Our study indicates that TT is associated with high mortality and bleeding rates in a relatively short period of time. Discontinuation of any TT drug did not increase the thromboembolic event rate, while it was associated with reduced risk of major bleeding.
authors.affiliation: Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Bogacki
authors.affiliation: Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Kabłak-Ziembicka
authors.affiliation: Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Bryniarski
authors.affiliation: Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
authors.forename: Leszek
authors.initials: L
authors.lastname: Wrotniak
authors.affiliation: Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Ostrowska-Kaim
authors.affiliation: Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Żmudka
authors.affiliation: Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Przewłocki
keywords: atrial fibrillation; bleeding and thromboembolic complications; cardiovascular events; coronary percutaneous intervention; triple anticoagulant therapy