Bridging therapy with low molecular weight heparin in patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation: The AFCAS study. (15th March 2015)

• Record Type: Journal Article
• Authors: Kiviniemi, Tuomas; Juhani Airaksinen, K.E.; Rubboli, Andrea; Biancari, Fausto; Valencia, Josè; Lip, Gregory Y.H.; Karjalainen, Pasi P.; Weber, Michael; Laine, Mika; Kirchhof, Paulus; Schlitt, Axel
• Is Part Of: International journal of cardiology. Volume 183(2015)
• Page Start: 105
• Page End: 110
• Publication Date: 2015-03-15
• Subjects: Coronary heart disease -- Atrial fibrillation -- Anticoagulation -- Bridging therapy; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.01.056
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Recent reports have provided evidence that bridging therapy with low-molecular-weight heparin (LMWH) may increase bleeding complications in patients with atrial fibrillation (AF) on oral anticoagulation undergoing percutaneous coronary intervention (PCI). We sought to assess mid-term bleeding and thromboembolic events in patients from the AFCAS registry discharged on triple therapy (TT). Methods: AFCAS is a multicenter, prospective registry enrolling patients with AF undergoing PCI. The primary endpoints were: 1) bleeding complications as defined by the bleeding academic research criteria (BARC); 2) a composite of cardiac and cerebrovascular events (MACCE) at 3 and 12 month follow-ups. Results: Altogether 663 out of 929 consecutive patients were discharged on TT, either on oral vitamin K antagonist (VKA-TT) (n = 498) or bridging LMWH-TT (n = 165). Patients on LMWH-TT had more often diabetes, heart failure, and hypertension compared to those on VKA-TT. The rates of major bleeding events (BARC ≥ 3) (11.5% vs. 6.0%, p = 0.03) as well as MACCE (11.5% vs. 5.0%, p = 0.006) were higher in the LMWH-TT group compared to VKA-TT group at 3 months follow-up. In a Cox multivariate regression model and propensity-score matched analysis LMWH-TT increased the risk for major BARC bleeding events at 3 and 12 month follow-ups. Conclusions: In this large, prospective, real-world population of patients with AF undergoing PCI patients discharged on LMWH-TT had a significantly higher risk for major bleeds in comparison to patients discharged on VKA-TT. LMWH-bridging therapy appeared harmful in this subset of patient on oral anticoagulation. Highlights: Bridging treatment with LMWH has been the standard recommendation for patients with AF undergoing PCI. We assessed the effect of LMWH-bridging therapy vs. uninterrupted oral anticoagulation therapy on adverse events in this patient subset. Patients on LMWH-triple therapy had a higher risk for major bleeds in comparison to patients on uninterrupted anticoagulation plus DAPT. LMWH-bridging therapy appeared harmful in this subset of patient on oral anticoagulation.