Direct Oral Anticoagulants (DOACs)-Based Versus
Warfarin-Based Antithrombotic Regimens in Patients
with Atrial Fibrillation Underwent Successful Coronary
Stenting at Siriraj Hospital
Polavith Chutisira MD¹, Nattawut Wongpraparut MD¹, Chunhakasem Chotinaiwattarakul MD²,
Rewat Phankingthongkum MD¹, Wiwun Tungsubutra MD¹, Narathip Chunhamaneewat MD¹,
Korakoth Towashiraporn MD², Asa Phichaphop MD², Pariya Panchavinin MD², Rungtiwa Pongakasira MSc²
Affiliation : ¹ Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand ² Her Majesty’s Cardiac center, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
Objective: To investigate the 1-year bleeding outcome between direct oral anticoagulants (DOACs)-based regimens and warfarin-based regimens
in real-world practice in Thai patients with atrial fibrillation (AF) and significant coronary artery disease (CAD).
Materials and Methods: The present study was a retrospective study. The authors reviewed the electronic medical charts of patients treated at the Siriraj Hospital between January 1, 2012 and October 31, 2019. The inclusion criteria were patients with AF and significant CAD that underwent percutaneous coronary intervention (PCI) with a stent and were prescribed or planned to prescribe anticoagulants after the PCI. The primary end point was the International Society on Thrombosis and Hemostasis (ISTH) bleeding during a 1-year follow-up period after successful coronary stenting. The trial assessed for the difference in the bleeding outcome and composite efficacy end point of myocardial infarction, ischemic stroke, and systemic embolism between patients that received warfarin-based regimen and those that received DOACs-based regimen.
Results: The prevalence of patients that received additional oral anticoagulation was 5.1% (679/13,306 patients). One hundred seventy patients met the study inclusion and exclusion criteria. The incidence of the primary end point was 9.0% in the warfarin-based regimen compared with 8.1% in the DOACs-based regimen (p=1.000). The incidence of the composite efficacy end point was 8.3% in the warfarin-based regimen compared with 0% in the DOACs-based regimen (p=0.124).
Conclusion: In patients with AF and significant CAD that underwent PCI, the use of a DOACs-based regimen had no statistically significant difference in bleeding outcome but associated with lower ischemic endpoint. However, due to the limited study sample size, the study had insufficient power to declare the results statistically significant.
Received 9 April 2021 | Revised 19 August 2021 | Accepted 20 August 2021
doi.org/10.35755/jmedassocthai.2021.10.12821
Keywords :
Coronary artery disease; Atrial fibrillation; DOAC; Warfarin
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