(134) Duration of Triple Antithrombotic Therapy in Patients With Atrial Fibrillation Following PCI

Introduction: Following percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is indicated. For patients with atrial fibrillation (AF) requiring anticoagulation undergoing PCI, the optimal duration of triple antithrombotic therapy (TAT), consisting of an anticoagulant and DAPT, is unclear. Current guidelines recommend that TAT be continued until hospital discharge or up to 1 week for most patients or up to 1 month in patients at increased thrombotic risk. However, these recommendations are largely based on expert opinion and post-hoc analyses of previous studies. In order to examine optimal duration of TAT in patients with AF following PCI, the primary objective of this study was to evaluate the effect of TAT duration on rates of bleeding. A secondary objective was to evaluate the effect of TAT duration on rates of ischemic events.

Methods: This study was a single center, retrospective cohort evaluation of patients with AF having undergone PCI. Patients were included if prescribed TAT with a direct oral anticoagulant and DAPT. Subject cohorts were determined based on TAT duration: less than 1 week (ultra-short group), between 1 week and 1 month (short group), or between 1 month and 1 year (extended group). The primary outcome was a composite of major or clinically relevant non-major bleeding events at 1 year. Secondary outcomes included ischemic events, hospitalization for revascularization, and death at 1 year.

Results: Thirty-nine patients were included and categorized into the three cohorts: ultra-short group, n=10 (25.6%); short group, n=24 (61.5%); extended group, n=5 (12.8%). The majority of patients were prescribed apixaban (84.6%) and clopidogrel (95.0%) in addition to aspirin to provide TAT. When comparing the three groups, there was no difference in the primary outcome at 1 year (10% vs 4% vs 20%; p=0.33). Additionally, there were no differences in ischemic events, hospitalization for revascularization, or death at 1 year.

Conclusions: This study did not find statistically significant differences in bleeding or thrombotic events with varying durations of TAT. However, the study is limited by sample size and the retrospective nature, so larger studies are needed.