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. 2023 Jun 6;5(7):282-288.
doi: 10.1253/circrep.CR-23-0047. eCollection 2023 Jul 10.

Temporal Trends in Antithrombotic Therapy for Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention From 2014 to 2022 in Japan

Yasuhiro Nakano  1 , Tetsuya Matoba  1 , Mitsutaka Yamamoto  2 , Shunsuke Katsuki  1 , Yasuaki Koga  3 , Yasushi Mukai  4 , Shujiro Inoue  5 , Nobuhiro Suematsu  6 , Taiki Higo  7 , Masao Takemoto  8 , Kenji Miyata  9 , Makoto Usui  10 , Toshiaki Kadokami  11 , Hideki Tashiro  12 , Kunio Morishige  13 , Kiyoshi Hironaga  14 , Hiroyuki Tsutsui  1   15 ; QcVIC Investigators
Affiliations

Temporal Trends in Antithrombotic Therapy for Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention From 2014 to 2022 in Japan

Yasuhiro Nakano et al. Circ Rep. .

Abstract

Background: Recent revisions of clinical guidelines by the Japanese Circulation Society, American Heart Association/American College of Cardiology, and European Society of Cardiology updated the management of antithrombotic strategies for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). However, the extent to which these guidelines have been implemented in real-world daily clinical practice is unclear. Methods and Results: We conducted surveys on the status of antithrombotic therapy for patients with AF undergoing PCI every 2 years from 2014 to 2022 in 14 cardiovascular centers in Japan. The primary use of drug-eluting stents increased from 10% in 2014 to 95-100% in 2018, and the use of direct oral anticoagulants increased from 15% in 2014 to 100% in 2018, in accordance with the revised practice guidelines. In patients with acute coronary syndrome, the duration of triple therapy within 1 month was approximately 10% until 2018, and increased to >70% from 2020. In patients with chronic coronary syndrome, the duration of triple therapy within 1 month was approximately 10% until 2016, and >75% from 2018. Since 2020, the most common timing of discontinuation of dual antiplatelet therapy to transition to anticoagulation monotherapy during the chronic phase of PCI has been 1 year after PCI. Conclusions: Japanese interventional cardiologists have updated their treatment strategies for patients with AF undergoing PCI according to revisions of clinical practice guidelines.

Keywords: Antithrombotic therapy; Atrial fibrillation; Percutaneous coronary intervention; Survey.

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Conflict of interest statement

T.M. has received personal fees from Abbott, Bayer Yakuhin, and MSD; research funding from Amgen, Bayer Yakuhin, and Kowa outside the submitted work; and is a member of Circulation Reports’ Editorial Team. H. Tsutsui has received lecture fees (Kowa, Teijin Pharma, Nippon Boehringer Ingelheim, Mitsubishi Tanabe Pharma, Pfizer Japan, Ono Pharmaceutical, Daiichi Sankyo, Novartis Pharma, Bayer Yakuhin, Otsuka Pharmaceuticalm, and AstraZeneca); manuscript fees (Nippon Rinsho); research funding (Mitsubishi Tanabe Pharma, Nippon Boehringer Ingelheim, IQVIA Services Japan, MEDINET, Medical Innovation Kyushu, Kowa, Daiichi Sankyo, Johnson & Johnson, and NEC Corporation); and scholarship funds (Abbott Medical Japan, Otsuka Pharmaceutical, Boston Scientific Japan, Ono Pharmaceutical, Bayer Yakuhin, Nippon Boehringer Ingelheim, St. Mary’s Hospital, Teijin Pharma, Daiichi Sankyo, and Mitsubishi Tanabe Pharma) outside the submitted work. The other authors declare no conflicts of interest with regard to this article.

Figures

Figure 1.
Figure 1.
Guidelines and trials of antithrombotic therapy after percutaneous coronary intervention (PCI) and survey schedule. ACS, acute coronary syndrome; AF, atrial fibrillation; AHA, American Heart Association; CCS, chronic coronary syndrome; DAPT, dual antiplatelet therapy; JCS, Japanese Circulation Society; M, months; OAC, oral anticoagulant; TAT, triple antithrombotic therapy; W, weeks. Trials: AFIRE, Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease; AUGUSTUS, An Open-Label, 2×2 Factorial, Randomized Controlled, Clinical Trial to Evaluate the Safety of Apixaban Versus Vitamin K Antagonist and Aspirin Versus Aspirin Placebo in Patients With Atrial Fibrillation and Acute Coronary Syndrome or Percutaneous Coronary Intervention; ENTRUST AF-PCI, Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation; PIONEER AF-PCI, Open-Label, Randomized, Controlled, Multicenter Study Exploring Two Treatment Strategies of Rivaroxaban and a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy in Subjects with Atrial Fibrillation who Undergo Percutaneous Coronary Intervention; PRASFIT-ACS, PRASugrel compared with clopidogrel For Japanese patIenTs with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention; RE-DUAL PCI, Randomized Evaluation of Dual Antithrombotic Therapy with Dabigatran versus Triple Therapy with Warfarin in Patients with Nonvalvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention OAC-Alone, Optimizing Antithrombotic Care in Patients With Atrial Fibrillation and Coronary Stent; STOPDAPT, Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent; STOPDAPT-2, Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2; WOEST, What is the Optimal antiplatElet and anticoagulant therapy in patients with oral anticoagulation and coronary StenTing.
Figure 2.
Figure 2.
(A) Estimated percentage of patients with atrial fibrillation (AF) or atrial flutter who undergo stent implantation (Question 1). (B) Frequency of bare-metal stent (BMS) implantation (Question 2). PCI, percutaneous coronary intervention.
Figure 3.
Figure 3.
Choice of direct oral anticoagulant (DOAC) vs. warfarin for anticoagulant (Question 3).
Figure 4.
Figure 4.
Duration of triple antithrombotic treatment in the case of (A) chronic coronary syndrome (CCS) or (B) acute coronary syndrome (ACS) plus drug-eluting stent (DES) implantation (Question 4).
Figure 5.
Figure 5.
(A) Antiplatelet agent stopped first and (B) its timing (Questions 5 and 6). mo, months; P2Y12i, P2Y12 inhibitor.
Figure 6.
Figure 6.
Preferred antithrombotic treatment strategy (Question 7). AC, anticoagulant; P2Y12i, P2Y12 inhibitor; TAT, triple antithrombotic therapy.
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