DAPT Use Variable After PCI With Atrial Fibrillation

HealthDay News – For patients with atrial fibrillation at moderate to high risk of stroke, dual antiplatelet therapy (DAPT) use is variable among those undergoing percutaneous coronary intervention (PCI), according to a study published in the August 22 issue of JACC: Cardiovascular Interventions.

Matthew W. Sherwood, MD, from the Duke University School of Medicine in Durham, North Carolina, and colleagues examined use of DAPT and outcomes in patients undergoing PCI in the ROCKET-AF trial (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation).

Researchers found that during a median of 806 days of follow-up, 1.1% of the 14 171 patients underwent PCI. Rivaroxaban-treated patients were significantly less likely to undergo PCI than those treated with warfarin (61 vs 92; P=.01). Eighty-one percent of patients continued the study drug during PCI. Long-term DAPT and single antiplatelet therapy were used in 37% and 34%, respectively. 

Within 30 days of PCI, 12.3% of patients switched from DAPT to monotherapy; 15% of patients received no antiplatelet therapy after PCI. In post-PCI patients, the rates of stroke/systemic embolism and major bleeding events were high in both treatment groups (4.5 and 10.2 per 100 patient-years, respectively).

“Rates of both thrombotic and bleeding events were high after PCI, highlighting the need for studies to determine the optimal antithrombotic therapy,” the authors wrote.

Disclosures: Several authors disclosed financial ties to the pharmaceutical industry.

References

1. Collet J-P, Guedeney P, Montalescot G. The triple challenge of triple therapy. JACC Cardiovasc Interv. 2016;9(16):1703-1705. doi:10.1016/j.jcin.2016.07.016.
2. Sherwood MW, Cyr DD, Jones WS, et al. Use of dual antiplatelet therapy and patient outcomes in those undergoing percutaneous coronary intervention. The ROCKET AF trial. JACC Cardiovasc Interv. 2016;9(16):1703-1705. doi:10.1016/j,jcin.2016.05.039.