Effect of New Evidence on Antithrombotic Therapies in Atrial Fibrillation Patients Who Undergo Percutaneous Coronary Intervention in Alberta, Canada

BACKGROUND: Trials have addressed the combined use of direct oral anticoagulants (DOACs) and antiplatelets in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI). These trials may have changed prescribing patterns. METHODS: This administrative audit of Albertans with AF undergoing PCI described antithrombotic therapy before vs after publication of the PIONEER AF-PCI (An Open-label, Randomized, Controlled, Multicenter Study Exploring Two Treatment Strategies of Rivaroxaban and a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy in Patients With Atrial Fibrillation Who Undergo Percutaneous Coronary Intervention) trial results. RESULTS: Cohorts were similar before (n = 597) and after (n = 708) trial publication: median age 72 years; 23% female; 63% with acute coronary syndrome; and 22% with bleeding history. Anticoagulant use increased by 7.0% (P = 0.01) after; with DOAC use increasing by 24.9% and warfarin use decreasing by 17.5% (P < 0.0001). DOAC use was associated with being in the “after” cohort (odds ratio 5.42, 95% confidence interval 3.75-7.82, P < 0.0001). CONCLUSIONS: Significantly more patients were prescribed anticoagulation therapy after the publication of the results of the PIONEER AF-PCI trial than before, and the choice of agent favoured DOAC over warfarin. Almost half of patients were not on anticoagulants, a situation that requires further investigation, to ensure that AF patients are being optimally managed post-PCI.