Efficacy and safety of aspirin, clopidogrel, and warfarin after coronary artery stenting in Korean patients with atrial fibrillation
- Authors
- Suh, Soon Yong; Kang, Woong Chol; Oh, Pyung Chun; Choi, Hanul; Moon, Chan Il; Lee, Kyounghoon; Han, Seung Hwan; Ahn, Taehoon; Choi, In Suck; Shin, Eak Kyun
- Issue Date
- Sep-2014
- Publisher
- SPRINGER
- Keywords
- Atrial fibrillation; Warfarin; Percutaneous coronary intervention; Stent
- Citation
- HEART AND VESSELS, v.29, no.5, pp.578 - 583
- Journal Title
- HEART AND VESSELS
- Volume
- 29
- Number
- 5
- Start Page
- 578
- End Page
- 583
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/12324
- DOI
- 10.1007/s00380-013-0399-x
- ISSN
- 0910-8327
- Abstract
- There are limited data on the optimal antithrombotic therapy for patients with atrial fibrillation (AF) who undergoing coronary stenting. We reviewed 203 patients (62.6 % men, mean age 68.3 +/- 10.1 years) between 2003 and 2012, and recorded clinical and demographic characteristics of the patients. Clinical follow-up included major adverse cardiac and cerebrovascular events (MACCE) (cardiac death, myocardial infarction, target lesion revascularization, and stroke), stent thrombosis, and bleeding. The most commonly associated comorbidities were hypertension (70.4 %), diabetes mellitus (35.5 %), and congestive heart failure (26.6 %). Sixty-three percent of patients had stroke risk higher than CHADS(2) score 2. At discharge, dual-antiplatelet therapy (aspirin, clopidogrel) was used in 166 patients (81.8 %; Group I), whereas 37 patients (18.2 %) were discharged with triple therapy (aspirin, clopidogrel, warfarin; Group II). The mean follow-up period was 42.0 +/- 29.0 months. The mean international normalized ratio (INR) in group II was 1.83 +/- 0.41. The total MACCE was 16.3 %, with stroke in 3.4 %. Compared with the group II, the incidence of MACCE (2.7 % vs 19.3 %, P = 0.012) and cardiac death (0 % vs 11.4 %, P = 0.028) were higher in the group I. Major and any bleeding, however, did not differ between the two groups. In multivariate analysis, no warfarin therapy (odds ratio 7.8, 95 % confidence interval 1.02-59.35; P = 0.048) was an independent predictor of MACCE. By Kaplan-Meier survival analysis, warfarin therapy was associated with a lower risk of MACCE (P = 0.024). In patients with AF undergoing coronary artery stenting, MACCE were reduced by warfarin therapy without increased bleeding, which might be related to tighter control with a lower INR value.
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