Comparative Effectiveness and Safety of Different Combinations of Antithrombotic Regimens in Atrial Fibrillation Patients With Stent Insertions

This study aims to compare the risks of major adverse cardiac events (MACEs), including cardiovascular death, myocardial infarction, ischemic stroke and transient ischemic attack, and major bleeding across different antithrombotic regimens in Asian patients with atrial fibrillation (AF) with stent insertions. We conducted a retrospective cohort study using Taiwan’s National Health Insurance Research Database and National Mortality Registry. A total of 10,208 patients with nonvalvular AF who had undergone percutaneous coronary intervention with stents for the first time in 2007–2017 were identified. Most patients (68.4%) were prescribed dual antiplatelet therapy (DAPT) at discharge. During follow-up, the use of anticoagulants increased, and double therapy (an antiplatelet plus an anticoagulant) was the most frequently prescribed therapy. The risks of MACEs were comparable in double therapy and had a similar risk of MACEs compared with DAPT (adjusted hazard ratio (aHR) 0.86, 95% confidence interval (CI) 0.67–1.11). Triple therapy (DAPT plus an anticoagulant) also had similar effectiveness to double therapy (aHR 1.23, 95% CI 0.84–1.80) or DAPT (aHR 1.06, 95% CI 0.77–1.45). However, triple therapy was associated with a nearly twofold higher major bleeding risk than DAPT and double therapy (aHR 1.97, 95% CI 1.31–2.94 and aHR 1.80, 95% CI 1.10–2.95, respectively). DAPT was the most frequently prescribed antithrombotic regimen at discharge for Asian patients with AF who had undergone stent insertions. DAPT and double and triple therapy had comparable effectiveness, but triple therapy had a significantly higher major bleeding risk than either DAPT or double therapy.