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Utilization of triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention

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Abstract

Background

Triple antithrombotic therapy (TAT), a combination of an oral anticoagulant and dual antiplatelet therapy (DAPT), is a key treatment for prevention of ischemic events in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). However, TAT is not extensively used because of the risk of bleeding. This study aimed to determine the utilization and influencing factors of TAT using real-world data in the non-vitamin K antagonist oral anticoagulants (NOACs) era.

Methods

We analyzed National Inpatient Sample data compiled by the Health Insurance Review & Assessment Service (HIRA-NIS) from 2011 to 2020. Patients with AF who underwent PCI with stent implantation and with an increased stroke risk were selected as candidates for TAT therapy. Demographic and clinical factors associated with TAT use were investigated using the chi-squared test and the Student t-test, and influencing factors were identified using multiple logistic regression.

Results

The TAT utilization rate steadily increased from 30.3% in 2011 to 65.4% in 2020 (Cochran-Armitage trend test: p < 0.001) with an average of 45.9%. Positive influencing factors for TAT use were identified as congestive heart failure, history of previous stroke/transient ischemic attack/thromboembolism, valvular heart disease, and year. Negative influencing factors included insurance type (medical aid or Patriots & Veterans Insurance), type of medical institution (general hospitals or primary medical institutions), and comorbidities such as renal disease, liver disease, and history of the previous hemorrhage.

Conclusions

The utilization of TAT following PCI among high-stroke risk AF patients steadily increased from 2011 to 2020, reaching 65.4% by the end of the study period. However, in 2020, a significant proportion of 29.4% of patients still received DAPT, indicating that many AF patients undergoing PCI did not receive adequate antithrombotic therapy.

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Data availability

The authors used the HIRA-NIS data for this study and do not have permission to share these data. Raw data can be accessed with permission from Health Insurance Review and Assessment Service in Korea (http://opendata.hira.or.kr).

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Acknowledgements

We used the Health Insurance Review & Assessment Service National Inpatient Sample (HIRA-NIS) from 2011 to 2020 (S20220802002) for this study; however, the results have no concern with the Ministry of Health and Welfare or HIRA.

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Authors and Affiliations

  1. College of Pharmacy, Pusan National University, Busandaehakro 63 Bungil 2, Geumjeong-Gu, Busan, 46241, Republic of Korea

    Hye-Jeong Choi, Yonghyuk Lee & Nam Kyung Je

  2. College of Pharmacy, Woosuk University, Samnye-ro 443 Samnye-eup, Wanju-gun, Jeollabuk-do, 55338, Republic of Korea

    Susin Park

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Contributions

SP and NKJ conceived and designed the study; HC and YL performed the analysis; HC first drafted the manuscript; All authors participated in drafting the article and approved the final version to be submitted for publication.

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Correspondence to Susin Park or Nam Kyung Je.

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The study protocol was approved by the Institutional Review Board (IRB) of Pusan National University, Busan, Korea (PNU IRB/2022_116_HR).

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Choi, HJ., Lee, Y., Park, S. et al. Utilization of triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention. Eur J Clin Pharmacol 79, 541–551 (2023). https://doi.org/10.1007/s00228-023-03468-6

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