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  • Single direct oral anticoagulant therapy in stable patients with atrial fibrillation beyond 1 year after coronary stent implantation

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Coronary artery disease
Original research
Single direct oral anticoagulant therapy in stable patients with atrial fibrillation beyond 1 year after coronary stent implantation
  1. Young Choi1,
  2. Yunhee Lee2,
  3. Sung-Hwan Kim1,
  4. Sunhwa Kim3,
  5. Ju Youn Kim4,
  6. Tae-Seok Kim5,
  7. Youmi Hwang6,
  8. Ji-Hoon Kim6,
  9. Sung-Won Jang7,
  10. Man Young Lee8,
  11. Yong-Seog Oh1
  1. 1 Division of Cardiology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  2. 2 Department of Occupational and Environmental Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  3. 3 Division of Cardiology, Department of Internal Medicine, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
  4. 4 Division of Cardiology, Department of Internal Medicine, Uijeongbu St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea
  5. 5 Division of Cardiology, Department of Internal Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea
  6. 6 Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
  7. 7 Division of Cardiology, Department of Internal Medicine, Eunpyeong St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  8. 8 Division of Cardiology, Department of Internal Medicine, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  1. Correspondence to Dr Yong-Seog Oh, Division of Cardiology, Department of Internal Medicine, Seoul St Mary's Hospital, Seoul 06591, South Korea; oys{at}catholic.ac.kr

Abstract

Objective Optimal antithrombotic therapy in patients with atrial fibrillation (AF) beyond 1 year after coronary stent implantation has not been well established in the era of direct oral anticoagulant (DOAC).

Methods Using Korean National Health Insurance Service data, we analysed 4294 patients with AF who were prescribed DOAC beyond 1 year after coronary stent implantation. Subjects were classified into the monotherapy group (DOAC single therapy, n=1221) or the combination therapy group (DOAC with an antiplatelet agent, n=3073). The primary ischaemic endpoint was defined as a composite of cardiovascular death, myocardial infarction, stroke or systemic thromboembolism. The secondary endpoints were all-cause death, major bleeding defined as a bleeding event requiring hospitalisation and net adverse clinical events. Propensity score matching was performed to balance baseline covariates.

Results Among included patients, 94% had drug-eluting coronary stents. During a median follow-up of 19 (7–32) months, the monotherapy group had a similar risk of the primary ischaemic endpoint (HR 0.828, 95% CI 0.660 to 1.038) and all-cause death (HR 1.076, 95% CI 0.895 to 1.294) compared with the combination therapy group. Risk of major bleeding was lower in the monotherapy group (HR 0.690, 95% CI 0.481 to 0.989), which was mostly driven by reduced gastrointestinal bleeding (HR 0.562, 95% CI 0.358 to 0.883). There was no significant difference in net adverse clinical events between the two groups.

Conclusions DOAC monotherapy showed similar efficacy in preventing ischaemic events and was associated with lower major bleeding events compared with combination therapy in patients with AF beyond 1 year after coronary stent implantation.

  • atrial fibrillation
  • percutaneous coronary intervention
  • angina pectoris
  • myocardial infarction

Data availability statement

No data are available. This study used national claim data that are not open to public.

https://doi.org/10.1136/heartjnl-2020-318750

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    Data availability statement

    No data are available. This study used national claim data that are not open to public.

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    Footnotes

    • Contributors YC drafted the manuscript. YC, SHK and YSO conceived and designed the study. YL mainly performed the analysis. SK, JYK, TSK, YH, JHK, SWJ and MYL contributed to revising the article and researching data. YSO substantially contributed to study conceptualisation and the completion of the manuscript. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.