Outcomes in relation to antithrombotic therapy among patients with atrial fibrillation after percutaneous coronary intervention

BACKGROUNDS: We investigated the prognostic impact of antithrombotic regimens at 1-year after percutaneous coronary intervention (PCI) among patients with atrial fibrillation (AF). METHOD AND RESULTS: A total of 13,278 AF patients who underwent PCI from 2009 to 2013 were selected from Korean National Health Insurance Service database. Patients were categorized by antithrombotic regimens at 1-year after PCI: (1) OAC with or without single antiplatelet (OAC±SAPT); (2) triple therapy (TT) and (3) antiplatelets (APT) only. After propensity score matching, composite ischaemia (death, myocardial infarction, and stroke), composite bleeding (intracranial hemorrhage and gastrointestinal bleeding), and a composite clinical outcome (composite ischaemia and bleeding) were compared. Of total population, 1,100 (8.3%), 746 (5.6%), and 11,432 (86.1%) were treated with OAC±SAPT, TT, and APT only, respectively. Compared to OAC±SAPT group, the TT group had significantly higher risk of the composite clinical outcome (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.00–2.13) attributed to a higher trend in both ischaemia (HR 1.63, 95% CI 0.99–2.67) and bleeding (HR 1.22, 95% CI 0.69–2.13). The APT only group showed a higher risk of ischaemia (HR 1.85, 95% CI 1.25–2.74), despite a lower risk of bleeding (HR 0.55, 95% CI 0.32–0.94) compared to OAC±SAPT group. CONCLUSIONS: OAC±SAPT was associated with better clinical outcomes compared to TT or APT only treatments, beyond 1-year after PCI among Asians with AF.