Dual and triple antithrombotic pharmacotherapy i n patients with coronary heart disease complicated with atrial fibrillation after percutaneous coronary intervention

Abstract

Purpose: To compare the influence of triple antithrombotic therapy (warfarin + aspirin + clopidogrel) and dual antithrombotic therapy (aspirin + clopidogrel) on the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with atrial fibrillation (AF) after coronary stent implantation.Methods: A total of 210 patients with coronary heart disease and complicated with AF, who underwent percutaneous coronary intervention (PCI) in The Third Affiliated Hospital of Chongqing Medical University, were enrolled. They were divided into a triple antithrombotic therapy group (TT group) and a dual antithrombotic therapy group (DT group). The risks of hemorrhage and MACCEs were evaluated via follow-up and multivariate regression analysis.Results: Based on the classification criteria for bleeding in Thrombolysis in Myocardial Infarction (TIMI) and Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO), there were 6 and 0 patients with significant hemorrhage in TT and DT groups, respectively, during the one year of follow-up (p = 0.013). The total number of MACCEs of 52 and 61 for both groups was not significantly different (p = 0.213). Moreover, the results of multivariate Cox regression analysis revealed that the histories of ischemia and stroke (p = 0.023), heart failure (p = 0.007), and high CHA2DS2-VASc score (p = 0.004) were the risk factors for MACCEs.Conclusion: Compared with dual antithrombotic therapy, triple antithrombotic therapy increases the risk of major hemorrhage in AF patients after PCI, but does not noticeably reduce the incidence of MACCEs during one year of follow-up.