International journal of cardiology | 2021
Antithrombotic strategies in elderly patients with atrial fibrillation revascularized with drug-eluting stents: PACO-PCI (EPIC-15) registry.
Abstract
BACKGROUND\nWe sought to investigate the antithrombotic regimens applied and their prognostic effects in patients over 75\u202fyears old with atrial fibrillation (AF) after revascularization with drug-eluting stents (DES).\n\n\nMETHODS\nRetrospective registry in 20 centers including patients over 75\u202fyears with AF treated with DES. A primary endpoint of MACCE and a co-primary endpoint of major bleeding by ISTH criteria were considered at 12\u202fmonths.\n\n\nRESULTS\nA total of 1249 patients (81.1\u202f±\u202f4.2\u202fyears, 33.1% women, 66.6% ACS, 30.6% complex PCI) were included. Triple antithrombotic therapy (TAT) was prescribed in 81.7% and dual antithrombotic therapy (DAT) in 18.3%. TAT was based on direct oral anticoagulants (DOAC) in 48.4% and maintained for only 1\u202fmonth in 52.2%, and DAT included DOAC in 70.6%. Primary endpoint of MACCE was met in 9.6% and primary endpoint of major bleeding in 9.4%. TAT was significantly associated with more bleeding (10.2% vs. 6.1%, p\u202f=\u202f0.04) but less MACCE (8.7% vs. 13.6%, p\u202f=\u202f0.02) than DAT and the use of DOAC was significantly associated to less bleeding (8% vs. 11.1%, p\u202f=\u202f0.03) and similar MACCE (9.8% vs. 9.4%, p\u202f=\u202f0.8). TAT over 1\u202fmonth or with VKA was associated with more major bleeding but comparable MACCE rates.\n\n\nCONCLUSIONS\nDespite advanced age TAT prevails, but duration over 1\u202fmonth or the use of other agent than Apixaban are associated with increased bleeding without additional MACCE prevention. DAT reduces bleeding but with a trade-off in terms of ischemic events. DOAC use was significantly associated to less bleeding and similar MACCE rates.