J Clin Med. 2021;10(7):jcm10071505.

Longitudinal Patterns in Antithrombotic Therapy in Patients with Atrial Fibrillation after Percutaneous Coronary Intervention in the Non-Vitamin K Oral Anticoagulant Era: A Nationwide Population-Based Study.

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제1저자 박지석, 정진형 · 교신저자 최의근

PMID 33916604 PMC8038511 DOI 10.3390/jcm10071505 IF 3.3 순환기내과

소속 (6)

Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.
Department of Internal Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea.
Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Korea.
Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Chest & Heart Hospital, Liverpool L14 3PE, UK.
Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark.

Abstract

We investigated whether longitudinal patterns in antithrombotic therapy have changed after the introduction of non-vitamin K oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI). Using a claims database of the Korean AF population who underwent PCI between 2012 and 2016 (n = 18,691), we analyzed prescription records of oral anticoagulants (OACs) and antiplatelets at 3-month intervals over 2 years after PCI. The study population was stratified (pre-NOAC, transition, and NOAC era) using time-periods of NOAC introduction in Korea and an expansion of reimbursement for NOAC in AF as indicators. The overall rates of OAC were low at baseline (24.9%, 26.9%, and 35.2% in pre-NOAC, transition, and NOAC era, respectively), contrary to high rates of dual antiplatelet therapy (DAPT) (73.3%, 71.4%, and 63.6%). However, OAC prescription rates were increased at 1-year (18.5%, 22.5%, and 31.6%), and 2-year follow-up (17.8%, 24.2%, and 31.8%) from pre-NOAC to NOAC era. In NOAC era, 63.5% of baseline OAC prescriptions comprised NOAC, of which 96.4% included triple therapy with DAPT. Over 2 years, we observed increasing rates of double therapy with a single antiplatelet (18.3% and 20.0% at 1- and 2-year follow-up) and OAC monotherapy (2.7% and 8.9% at 1- and 2-year follow-up).

Keywords

anticoagulationantiplateletsatrial fibrillationnon-vitamin K oral anticoagulantpercutaneous coronary intervention

Figures

**Figure 1** Two-year patterns in antithrombotic therapy after percutaneous coronary intervention in patients with atrial fibrillation. The figure represents 2-year patterns in antithrombotic therapy after PCI in pre-NOAC era (A), transition era (B), and NOAC era (C). In all three cohorts, prescription rates of OACs were substantially low over the 2-year period, whereas DAPT was the major type of antithrombotic therapy after PCI. (left panel of A–C). VKAs were the dominant type of OACs in the pre-NOAC and transition era. However, NOACs were preferred to VKAs in all OACs regimens in the NOAC era (right panel of A–C). DAPT: dual antiplatelet therapy; OAC: oral anticoagulant; N: non-vitamin K oral anticoagulant; PCI: percutaneous coronary intervention; SAPT: single antiplatelet therapy; W: warfarin.

**Figure 2** Comparison of prescription rates of overall oral anticoagulants and non-vitamin K oral anticoagulants between the study cohorts. The figure shows the prescription rates of OACs (A) and the proportions of NOACs in overall OACs prescriptions (B) compared between the three cohorts in every 3-month time interval. In each period, the prescription rates of OACs and the proportions of NOACs were significantly increased from pre-NOAC to NOAC era. OACs: oral anticoagulants; NOACs: non-vitamin K oral anticoagulants.

**Figure 3** Clinical factors associated with preference for oral anticoagulants use 1 year after percutaneous coronary intervention. Old age (≥65 years), previous congestive heart failure, stroke or thromboembolism, and a high CHA₂DS₂-VASc score (≥2) were associated with OACs use at the 1-year period. In contrast, female sex, previous myocardial infarction, peripheral arterial disease, dyslipidemia, chronic liver or renal disease were associated with no OACs use at the 1-year period. CI: confidence interval; OACs: oral anticoagulants; PCI: percutaneous coronary intervention.

**Figure 4** Clinical factors associated with preference for oral anticoagulant monotherapy compared with combination regimens or antiplatelet-only therapy 1 year after percutaneous coronary intervention. Among the clinical factors, previous gastrointestinal bleeding was associated with a preference for OAC monotherapy over combination regimens, whereas dyslipidemia was associated with a preference for combination regimens (A). Previous gastrointestinal bleeding was also associated a preference for OAC monotherapy than antiplatelet-only therapy. However, previous MI and dyslipidemia were associated with a preference for antiplatelet-only therapy (B). CI: confidence interval; OAC: oral anticoagulant; PCI: percutaneous coronary intervention.

그림 출처: PubMed Central 공개 논문 (PMC8038511)

Conflict of interest statement

J.P., J.-H.J., S.-W.L., S.K., S.-R.L., J.K., K.-D.H., K.-W.P., S.O.: None. E.-K.C.: Received research grants from Bayer; BMS/Pfizer; Biosense Webster, Inc.; Chong Kun Dang Pharmaceutical Corp.; Daiichi-Sankyo, Samjin Pharmaceutical Co. Ltd.; Sanofi-Aventis; Seers Technology Co. Ltd.; Skylabs; and Yuhan Corp. No fees were directly received personally. G.Y.H.L.: Consultant for Bayer and Janssen Pharmaceuticals; BMS/Pfizer; Medtronic; Boehringer Ingelheim; Novartis; Verseon Corp.; and Daiichi-Sankyo; speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees were received personally.

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