Abstract 17586: Should We Recommend Triple Therapy in Patients With Atrial Fibrillation With Chads2 Score = 2 Undergoing Coronary Stent?
Background: In the European guidelines about atrial fibrillation (AF), in patients with low-moderate thromboembolic risk (CHADS2 ≤ 2) oral anticoagulation is recommended. When in these patients a coronary stent (CS) is implanted, indication to dual antiplatelet therapy (DAPT) is added, so these patients may be receiving triple therapy (TT).
Objectives: to assess the impact of TT in the rate of occurrence of adverse events, in patients with AF and low-moderate thromboembolic risk in whom a CS is implanted.
Methods: we conducted a multicenter prospective study from 2007 to 2011 including patients with non-valvular AF undergoing CS. We assessed mortality (total and cardiovascular), thromboembolic and hemorrhagic events at 1 year follow-up.
Results: We identified 640 patients with AF (75% men, 73.2 ± 8.2 years). 409 (76.5%) had CHADS2 ≤ 2 and 52% of them were receiving OAC (45.4% OAC plus DAPT: TT; 6.6% OAC + clopidogrel). Baseline characteristics were similar in both groups, including HASBLED ≥ 3 (15.5% vs 12.3%; p=0.22). At follow-up, patients on OAC showed a lower incidence of thromboembolism (1.4% vs 5.7%; p=0.01). However, they showed a higher mortality (8.8% vs 4.1%; p=0.04) due to an excess of cardiovascular mortality (7.4% vs 1.5%; p=0.004) and more bleedings (7% vs 1%; p=0.002). Both groups had a similar incidence of MACE (13.5% vs. 13.9%; p=0.51) and MAE (25.6% vs 24.2; p=0.41). Twenty-seven patients (6.6%) died during follow-up,19 (70.4%) were on OAC; 6 died because of a bleeding event and 2 of them had CHADS2 = 1. In a multivariate analysis, in patients with CHADS2 ≤ 2, OAC therapy was an independent predictor of an increased mortality (OR 2.4, 95% CI 1.01 - 5.7; p=0.04) due to cardiovascular mortality (OR 4.8, 95% CI 1.33-17.43; p=0.017), and of an increased rate of major bleedings (OR 7.8, 95% CI 1.7-35.5; p=0.008).
Conclusions: In patients with non-valvular AF and CHADS2 ≤ 2 submitted to CS, the combination of OAC and DAPT, reduces the incidence of thromboembolic events, but increases the cardiovascular mortality and the incidence of major bleedings.
- © 2013 by American Heart Association, Inc.