Safety and Efficacy of Dual Antiplatelet versus Triple Antithrombotic Therapies in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention and Stenting in Phitsanulok
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Abstract
Objective: To compare safety from major bleeding complication and incidence of Major adverse cardiac and cerebrovascular events (MACCE) of dual antiplatelet versus triple antithrombotic therapy (DAPT and TT) in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) and stenting in Phitsanulok. Method: This research was a retrospective cohort study with one year follow up. The study collected the data during January 1, 2010 to September 30, 2015 in Buddhachinaraj Phitsanulok Hospital and Naresuan University Hospital. Data were retrieved from computerized database of the hospitals and reviewed for their validity. Data unavailable in the database were collected from medical records of outpatients and in-patients. A total of 232 patients were enrolled. Patients were classified into 2 groups i.e. 127 subjects in the DAPT group receiving aspirin plus clopidogrel and 105 subjects in the TT group receiving aspirin plus clopidogrel and warfarin. Outcome variables included overall bleeding, major bleeding and MACCE. Results: Major bleeding was found in 4 (3.15%) and 12 patients (11.43%) in DAPT and TT group, respectively (P=0.013). Overall bleeding was found in 4 (3.15%) and 21 patients (20.00%) in DAPT and TT group, respectively (P<0.001). MACCE was identified in 57 (44.88%) and 30 patients (28.57%) in DAPT and TT group, respectively (P=0.011). Net clinical outcomes (NACE), a composite of major bleeding and MACCE, were found in 61 (48.03%) and 42 patients (40.00%) (P=0.220) in DAPT and TT group, respectively. Conclusion: Patients receiving TT appears to have a higher risk of bleeding but having a lower risk of MACCE than those in the DAPT group. In addition, those in the TT group show a lower, but insignificant, risk of NACE than those in the DAPT group. Therefore, TT may benefit patients with AF undergoing PCI and stenting with the monitoring of bleeding and consideration of others factors affecting drug use.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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