Antithrombotic Therapy and Outcomes After ICD Implantation in Patients With Atrial Fibrillation and Coronary Artery Disease: An Analysis From the National Cardiovascular Data Registry (NCDR)(®)

BACKGROUND: Management of antithrombotic agents after implantable cardioverter defibrillator implantation is challenging, particularly among patients with atrial fibrillation and coronary artery disease. METHODS AND RESULTS: Using data from National Cardiovascular Data Registry(®) Implantable Cardioverter Defibrillator Registry(™) linked with Medicare claims data, we identified 25 180 patients with atrial fibrillation and coronary artery disease who underwent implantable cardioverter defibrillator implantation. Patients were categorized into 5 different groups according to antithrombotic agents prescribed at discharge (any 1 antiplatelet agent [A, n=6538], dual antiplatelet therapy [DA, n=3414], warfarin [n=5264], warfarin+A [n=7994], warfarin+DA [n=1970]). We assessed the primary outcomes occurring within 30 days of hospital discharge. Combinations of DA (adjusted hazard ratio [HR]: 1.39; 95% CI: 1.03 to 1.87), warfarin+A (adjusted HR: 1.32; 95% CI: 1.03 to 1.69), and warfarin+DA (adjusted HR: 2.03; 95% CI: 1.49 to 2.77) were associated with a higher bleeding risk. The risk of major adverse cardiovascular events was higher in patients discharged with A (adjusted HR: 1.69; 95% CI: 1.33 to 2.16), DA (adjusted HR: 2.17; 95% CI: 1.66 to 2.83), and DA+warfarin (adjusted HR: 1.61; 1.16 to 2.24). There was no association between postdischarge antithrombotic agents and thromboembolic events or device‐related complications. CONCLUSIONS: Short‐term bleeding risk and major adverse cardiovascular events differ with usage patterns of antithrombotic agents, while the risk of thromboembolic events and device‐related complications is relatively constant. These data may help clinicians balance risks and benefits when choosing antithrombotic therapy following implantable cardioverter defibrillator implantation.