Abstract 15956: Triple Versus Dual Antithrombotic Therapy in Patients With Atrial Fibrillation and History of Coronary Artery Disease: Insights From the ORBIT-AF Registry
Background: Patients with atrial fibrillation (AF) and coronary artery disease (CAD) are common in clinical practice and antithrombotic therapy is challenging in this population. Little is known about how these different antithrombotic agents are used in the current era as well as associated clinical outcomes.
Methods: We analyzed data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Triple therapy (TT) was defined as an oral anticoagulant plus aspirin plus a thienopyridine, while dual therapy 1 (DT1) as an oral anticoagulant plus an antiplatelet agent, and dual therapy 2 (DT2) as 2 antiplatelet agents at baseline.
Results: From the overall AF patients (N=10,132) from 176 outpatient practices enrolled in ORBIT-AF from 2010 to 2011, 1695 patients (16.7%) had CAD and were on TT, DT1, or DT2. In patients with CAD, the use of TT, DT1, and DT2 at baseline was 9.0%, 79.5%, and 11.5%, respectively. Among patients on DT1, aspirin was the most common antiplatelet agent used (88.8%), followed by clopidogrel (11.0%), and prasugrel (0.2%). Among patients treated with DT2, aspirin was used in 100% of the patients, clopidogrel in 95.9%, and prasugrel in 4.1%. Of patients receiving TT, DT1, and DT2 at baseline, 37.5%, 71.0%, and 61.2% remained on these treatments at 1 year, respectively. Patients on TT were more often hospitalized for both all-cause and cardiovascular cause when compared with patients on DT1 (Table). Similar results were seen when TT was compared with DT2.
Conclusion: Triple therapy was used in 9.0% of the patients with AF and CAD. Of these patients, only 37.5% were still on this regimen after 1 year. Dual therapy with 1 oral anticoagulant and 1 antiplatelet agent was the most common antithrombotic treatment for this high-risk population. Patients on TT were more likely to be hospitalized when compared with patients on dual antithrombotic therapy regimens.
- © 2013 by American Heart Association, Inc.