Experiences of Patients With Atrial Fibrillation With Combination Antithrombotic Therapy Post–Percutaneous Coronary Intervention

Up to 30% of patients with atrial fibrillation (AF) have coronary artery disease, and many undergo percutaneous coronary intervention (PCI). In the setting of acute coronary syndrome with PCI, or high-risk elective PCI, Canadian AF guidelines recommend 1-30 days of acetylsalicylic acid, 1-12 months of clopidogrel, and oral anticoagulation (OAC) with doses that may change throughout the 12 months post-PCI. The complexity of these regimens may contribute to unplanned modifications (UPMs), increasing the risk of thrombosis and/or bleeding. We describe what happens to these patients and their antithrombotic therapy (ATT) after discharge. Prospective follow-up was conducted of patients with AF requiring OAC who underwent PCI and were discharged on combination ATT. Patients were contacted at 1, 3, 6, and 12 months post-PCI. Sixty-five patients were enrolled, with data at any time point available for 61 of them (94%). Of these, 44 (68%) experienced at least one UPM to ATT. In total, 105 UPMs occurred. The most common UPM was an extended duration of P2Y12 inhibitor (23 instances; 22%). The most common UPM with acetylsalicylic acid was extended (11 instances; 11%) or shortened (11 instances; 11%) duration. Thirty-nine UPMs (37%) were related to OACs; 9 (23%) were related to warfarin, and 30 (77%) were related to direct OACs. Of all patients with at least one UPM, 33 (75%) experienced bleeding. More than 2 in 3 patients with AF undergoing PCI experienced a UPM to their ATT. This study underscores the challenges of combination ATT for patients and clinicians alike, emphasizing the need for patient support after discharge. Jusqu’à 30 % des patients atteints de fibrillation auriculaire (FA) ont une coronaropathie, et nombre d’entre eux doivent subir une intervention coronarienne percutanée (ICP). En présence d’un syndrome coronarien aigu nécessitant une ICP ou dans le cas d’une ICP non urgente associée à un risque élevé, on recommande, dans les lignes directrices canadiennes sur la FA, un traitement de 1 à 30 jours par l’acide acétylsalicylique, de 1 à 12 mois par le clopidogrel, et une anticoagulothérapie orale (ACO) à des doses pouvant varier durant les 12 mois suivant l’ICP. La complexité de ces schémas posologiques peut contribuer à des modifications non planifiées (MNP) du traitement, ce qui accroît le risque de thrombose et/ou de saignement. Nous décrivons ce qui advient de ces patients et de leur traitement antithrombotique (TAT) après le congé de l’hôpital. Un