Antithrombotic strategies in elderly patients with atrial fibrillation revascularized with drug-eluting stents

Destacados, iEpic
Epic 15, iEpic, PACO PCI

Jose M. de la Torre Hernandez, José L. Ferreiro, Ramon Lopez-Palop, Soledad Ojeda, David Marti, Pablo Avanzas, Jose A. Linares, Alejandro Diego, Ignacio J. Amat, Miren Telleria, Belen Cid, Imanol Otaegui, Iñigo Lozano, David Serrano, Eduardo Pinar, Rafael González-Manzanares, Ricardo Concepción-Suárez, Isaac Pascual, Cristobal Urbano, Mario Sadaba, Marcos Garcia-Guimaraes, Joan F. Andres-Cordon, Felipe Hernandez, Angel Sanchez-Recalde, Celia Garilleti, Armando Perez de Prado.

Background: We sought to investigate the antithrombotic regimens applied and their prognostic effects in patients over 75 years old with atrial fibrillation (AF) after revascularization with drug-eluting stents (DES).

Methods: Retrospective registry in 20 centers including patients over 75 years with AF treated with DES. A primary endpoint of MACCE and a co-primary endpoint of major bleeding by ISTH criteria were considered at 12 months.

Results: A total of 1249 patients (81.1 ± 4.2 years, 33.1% women, 66.6% ACS, 30.6% complex PCI) were included. Triple antithrombotic therapy (TAT) was prescribed in 81.7% and dual antithrombotic therapy (DAT) in 18.3%. TAT was based on direct oral anticoagulants (DOAC) in 48.4% and maintained for only 1 month in 52.2%, and DAT included DOAC in 70.6%. Primary endpoint of MACCE was met in 9.6% and primary endpoint of major bleeding in 9.4%. TAT was significantly associated with more bleeding (10.2% vs. 6.1%, p = 0.04) but less MACCE (8.7% vs. 13.6%, p = 0.02) than DAT and the use of DOAC was significantly associated to less bleeding (8% vs. 11.1%, p = 0.03) and similar MACCE (9.8% vs. 9.4%, p = 0.8). TAT over 1 month or with VKA was associated with more major bleeding but comparable MACCE rates.

Conclusions: Despite advanced age TAT prevails, but duration over 1 month or the use of other agent than Apixaban are associated with increased bleeding without additional MACCE prevention. DAT reduces bleeding but with a trade-off in terms of ischemic events. DOAC use was significantly associated to less bleeding and similar MACCE rates.

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