AnticoagulantandAntiplateletTherapyinPatientsWithAtrial Fibrillation Undergoing Percutaneous Coronary Intervention

The prevalence, intensity, safety, and efficacy of oral anticoagulation (OAC) in addition to dual antiplatelet therapy (DAPT) in “real-world” patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) have not yet been fully evaluated. In the Coronary REvascularization Demonstrating Outcome Study in Kyoto registry cohort-2, a total of 1,057 patients with AF (8.3%) were identified among 12,716 patients undergoing first PCI. Cumulative 5-year incidence of stroke was higher in patients with AF than in no-AF patients (12.8% vs 5.8%, p <0.0001). Although most patients with AF had CHADS2 score ‡2 (75.2%), only 506 patients (47.9%) received OAC with warfarin at hospital discharge. Cumulative5-yearincidence of strokein theOAC group wasnotdifferent from that in thenoOAC group (13.8% vs 11.8%, p [ 0.49). Time in therapeutic range (TTR) was only 52.6% with an international normalized ratio of 1.6 to 2.6, and only 154 of 409 patients (37.7%) with international normalized ratio data had TTR ‡65%. Cumulative 5-year incidence of stroke in patients with TTR ‡65% was markedly lower than that in patients with TTR <65% (6.9% vs 15.1%, p [ 0.01). In a 4-month landmark analysis in the OAC group, there was a trend for higher cumulative incidences of stroke and major bleeding in the on-DAPT (n [ 286) than in the off-DAPT (n [ 173) groups (15.1% vs 6.7%, p [ 0.052 and 14.7% vs 8.7%, p [ 0.10, respectively). In conclusion, OAC was underused and its intensity was mostly suboptimal in real-world patients with AF undergoing PCI, which lead to inadequate stroke prevention. Long-term DAPT in patients receiving OAC did not reduce stroke incidence. 2014 The Authors. Published by Elsevier Inc. All rights reserved. (Am J Cardiol 2014;114:70e78)