Cardiovasc Prev Pharmacother.  2019 Jul;1(1):19-29. 10.36011/cpp.2019.1.e1.

Role of Novel Oral Anticoagulant for Patient with Atrial Fibrillation Underwent Percutaneous Coronary Intervention

• Bae JW

• KMID: 2536960
• DOI: http://doi.org/10.36011/cpp.2019.1.e1

Abstract

Atrial fibrillation (AF) is very common arrhythmic disorder especially in elderly population, and makes higher major adverse cardiac events (MACEs) in the patients with acute coronary syndrome (ACS) or underwent percutaneous coronary intervention (PCI). Pivotal drug for AF patients to reduce systemic embolism was warfarin, and certain duration of dual antiplatelet therapy (DAPT) is important after PCI with stent. But, best regimen of antithrombotic agent after PCI in AF is unclear especially in the clinical use of novel oral anticoagulant (NOAC). This manuscript will deal those clinical studies to indicate optimal regimen and duration of NOAC use for AF patients underwent PCI. NOAC use on DAPT significantly reduces major or minor bleeding compared to warfarin in AF patients with ACS or underwent PCI. But, the duration of NOAC use is still unclear, and there is exist clear contraindication to use it in clinical field. NOAC use reduced major or minor bleeding significantly compared to warfarin, but the incidence of MACEs was similar between warfarin and NOAC. Physician should understand the advantage or disadvantage of NOAC use, and be able to tailor the regimen and duration of antithrombotics including NOAC in this higher risk patient population.

Keyword

Atrial fibrillation; Anticoagulants; Percutaneous coronary intervention; Bleeding

Reference

1. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P; ESC Committee for Practice Guidelines-CPG; Document Reviewers. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. Europace. 2012; 14:1385–413.

2. Joung B, Lee JM, Lee KH, Kim TH, Choi EK, Lim WH, Kang KW, Shim J, Lim HE, Park J, Lee SR, Lee YS, Kim JB; KHRS Atrial Fibrillation Guideline Working Group. 2018 Korean guideline of atrial fibrillation management. Korean Circ J. 2018; 48:1033–80.

3. King SB 3rd, Smith SC Jr, Hirshfeld JW Jr, Jacobs AK, Morrison DA, Williams DO; 2005 WRITING COMMITTEE MEMBERS, Feldman TE, Kern MJ, O'Neill WW, Schaff HV, Whitlow PL, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW. 2007 focused update of the ACC/ AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association task force on practice guidelines: 2007 writing group to review new evidence and update the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention, writing on behalf of the 2005 Writing Committee. Circulation. 2008; 117:261–95.

4. Hwang KK, Eom SY, Lee SY, Kim SM, Cho MC, Kim YJ, Seung KB, Jeong MH, Bae JW; The other Korea Acute Myocardial Infarction Registry Investigators. Atrial fibrillation on admission is related with higher mortality in ST-segment elevation myocardial infarction patients. Int Heart J. 2017; 58:486–94.

5. Almendro-Delia M, Valle-Caballero MJ, Garcia-Rubira JC, Muñoz-Calero B, Garcia-Alcantara A, ReinaToral A, Benítez-Parejo J, Hidalgo-Urbano R; ARIAM Andalucia Study Group. Prognostic impact of atrial fibrillation in acute coronary syndromes: results from the ARIAM registry. Eur Heart J Acute Cardiovasc Care. 2014; 3:141–8.

6. Rene AG, Généreux P, Ezekowitz M, Kirtane AJ, Xu K, Mehran R, Brener SJ, Stone GW. Impact of atrial fibrillation in patients with ST-elevation myocardial infarction treated with percutaneous coronary intervention (from the HORIZONS-AMI [harmonizing outcomes with revascularization and stents in acute myocardial infarction] trial). Am J Cardiol. 2014; 113:236–42.

7. Bang CN, Gislason GH, Greve AM, Bang CA, Lilja A, Torp-Pedersen C, Andersen PK, Køber L, Devereux RB, Wachtell K. New-onset atrial fibrillation is associated with cardiovascular events leading to death in a first time myocardial infarction population of 89,703 patients with long-term follow-up: a nationwide study. J Am Heart Assoc. 2014; 3:e000382.

8. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009; 361:1139–51.

9. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L; ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365:981–92.

10. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM; ROCKET AF investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365:883–91.

11. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, Waldo AL, Ezekowitz MD, Weitz JI, Špinar J, Ruzyllo W, Ruda M, Koretsune Y, Betcher J, Shi M, Grip LT, Patel SP, Patel I, Hanyok JJ, Mercuri M, Antman EM; ENGAGE AF-TIMI 48 Investigators. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013; 369:2093–104.

12. Gibson CM, Mehran R, Bode C, Halperin J, Verheugt FW, Wildgoose P, Birmingham M, Ianus J, Burton P, van Eickels M, Korjian S, Daaboul Y, Lip GY, Cohen M, Husted S, Peterson ED, Fox KA. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med. 2016; 375:2423–34.

13. Cannon CP, Bhatt DL, Oldgren J, Lip GY, Ellis SG, Kimura T, Maeng M, Merkely B, Zeymer U, Gropper S, Nordaby M, Kleine E, Harper R, Manassie J, Januzzi JL, Ten Berg JM, Steg PG, Hohnloser SH; RE-DUAL PCI Steering Committee and Investigators. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med. 2017; 377:1513–24.

14. Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R, Goodman SG, Windecker S, Darius H, Li J, Averkov O, Bahit MC, Berwanger O, Budaj A, Hijazi Z, Parkhomenko A, Sinnaeve P, Storey RF, Thiele H, Vinereanu D, Granger CB, Alexander JH; AUGUSTUS Investigators. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med. 2019; 380:1509–24.

15. Sutton NR, Seth M, Ruwende C, Gurm HS. Outcomes of patients with atrial fibrillation undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2016; 68:895–904.

16. Choi HI, Ahn JM, Kang SH, Lee PH, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park DW, Park SJ. Prevalence, management, and long-term (6-year) outcomes of atrial fibrillation among patients receiving drug-eluting coronary stents. JACC Cardiovasc Interv. 2017; 10:1075–85.

17. Batra G, Svennblad B, Held C, Jernberg T, Johanson P, Wallentin L, Oldgren J. All types of atrial fibrillation in the setting of myocardial infarction are associated with impaired outcome. Heart. 2016; 102:926–33.

18. Rogacka R, Chieffo A, Michev I, Airoldi F, Latib A, Cosgrave J, Montorfano M, Carlino M, Sangiorgi GM, Castelli A, Godino C, Magni V, Aranzulla TC, Romagnoli E, Colombo A. Dual antiplatelet therapy after percutaneous coronary intervention with stent implantation in patients taking chronic oral anticoagulation. JACC Cardiovasc Interv. 2008; 1:56–61.

19. Chaudhary N, Bundhun PK, Yan H. Comparing the clinical outcomes in patients with atrial fibrillation receiving dual antiplatelet therapy and patients receiving an addition of an anticoagulant after coronary stent implantation: a systematic review and meta-analysis of observational studies. Medicine (Baltimore). 2016; 95:e5581.

20. Sørensen R, Hansen ML, Abildstrom SZ, Hvelplund A, Andersson C, Jørgensen C, Madsen JK, Hansen PR, Køber L, Torp-Pedersen C, Gislason GH. Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data. Lancet. 2009; 374:1967–74.

21. Mega JL, Braunwald E, Wiviott SD, Bassand JP, Bhatt DL, Bode C, Burton P, Cohen M, Cook-Bruns N, Fox KA, Goto S, Murphy SA, Plotnikov AN, Schneider D, Sun X, Verheugt FW, Gibson CM; ATLAS ACS 2-TIMI 51 Investigators. Rivaroxaban in patients with a recent acute coronary syndrome. N Engl J Med. 2012; 366:9–19.

22. Gibson CM, Mega JL, Burton P, Goto S, Verheugt F, Bode C, Plotnikov A, Sun X, Cook-Bruns N, Braunwald E. Rationale and design of the anti-Xa therapy to lower cardiovascular events in addition to standard therapy in subjects with acute coronary syndrome-thrombolysis in myocardial infarction 51 (ATLAS-ACS 2 TIMI 51) trial: a randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of rivaroxaban in subjects with acute coronary syndrome. Am Heart J. 2011; 161:815–821. e6.

23. Gibson CM, Chakrabarti AK, Mega J, Bode C, Bassand JP, Verheugt FW, Bhatt DL, Goto S, Cohen M, Mohanavelu S, Burton P, Stone G, Braunwald E; ATLAS-ACS 2 TIMI 51 Investigators. Reduction of stent thrombosis in patients with acute coronary syndromes treated with rivaroxaban in ATLAS-ACS 2 TIMI 51. J Am Coll Cardiol. 2013; 62:286–90.

24. Mega JL, Braunwald E, Murphy SA, Plotnikov AN, Burton P, Kiss RG, Parkhomenko A, Tendera M, Widimsky P, Gibson CM. Rivaroxaban in patients stabilized after a ST-segment elevation myocardial infarction: results from the ATLAS ACS-2-TIMI-51 trial (anti-Xa therapy to lower cardiovascular events in addition to standard therapy in subjects with acute coronary syndrome-thrombolysis in myocardial infarction-51). J Am Coll Cardiol. 2013; 61:1853–9.

25. Korjian S, Daaboul Y, Laliberté F, Zhao Q, Mehran R, Bode C, Halperin J, Verheugt FW, Lip GY, Cohen M, Peterson ED, Fox KA, Gibson CM, Pinto DS; PIONEER AF-PCI Investigators. Cost implications of anticoagulation strategies after percutaneous coronary intervention among patients with atrial fibrillation (a PIONEER-AF PCI analysis). Am J Cardiol. 2019; 123:355–60.

26. Cannon CP, Gropper S, Bhatt DL, Ellis SG, Kimura T, Lip GY, Steg PG, Ten Berg JM, Manassie J, Kreuzer J, Blatchford J, Massaro JM, Brueckmann M, Ferreiros Ripoll E, Oldgren J, Hohnloser SH; RE-DUAL PCI Steering Committee and Investigators. Design and rationale of the RE-DUAL PCI trial: a prospective, randomized, phase 3b study comparing the safety and efficacy of dual antithrombotic therapy with dabigatran etexilate versus warfarin triple therapy in patients with non-valvular atrial fibrillation who have undergone percutaneous coronary intervention with stenting. Clin Cardiol. 2016; 39:555–64.

27. Ako J, Okumura K, Nakao K, Kozuma K, Morino Y, Okazaki K, Fukaya T, Kimura T; RE-DUAL PCI Trial Investigators. Dual anti-thrombotic therapy with dabigatran after percutaneous coronary intervention in atrial fibrillation-Japanese and East-Asian subgroup analysis of the RE-DUAL PCI trial. Circ J. 2019; 83:327–33.

28. Kim JH, Choi W, Kim KC, Nam CW, Hong BK, Kim JH, Jeon DS, Bae JW, Kim SH, Moon KW, Cho BR, Kim DI, Jang JS. The current status of intervention for intermediate coronary stenosis in the Korean percutaneous coronary intervention (K-PCI) registry. Korean Circ J. 2019 Jun 5 [E-pub ahead of print]. https://doi.org/10.4070/kcj.2019.0074.

29. ACTIVE Writing Group of the ACTIVE Investigators, Connolly S, Pogue J, Hart R, Pfeffer M, Hohnloser S, Chrolavicius S, Pfeffer M, Hohnloser S, Yusuf S. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events (ACTIVE W): a randomised controlled trial. Lancet. 2006; 367:1903–12.

30. ACTIVE Investigators, Connolly SJ, Pogue J, Hart RG, Hohnloser SH, Pfeffer M, Chrolavicius S, Yusuf S. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med. 2009; 360:2066–78.

31. Hurlen M, Abdelnoor M, Smith P, Erikssen J, Arnesen H. Warfarin, aspirin, or both after myocardial infarction. N Engl J Med. 2002; 347:969–74.

32. van Es RF, Jonker JJ, Verheugt FW, Deckers JW, Grobbee DE; Antithrombotics in the Secondary Preventionof Events in Coronary Thrombosis-2 (ASPECT-2) Research Group. Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial. Lancet. 2002; 360:109–13.

33. Hsu JC, Maddox TM, Kennedy KF, Katz DF, Marzec LN, Lubitz SA, Gehi AK, Turakhia MP, Marcus GM. Oral anticoagulant therapy prescription in patients with atrial fibrillation across the spectrum of stroke risk: insights from the NCDR PINNACLE registry. JAMA Cardiol. 2016; 1:55–62.

34. Lee SR, Choi EK, Han KD, Cha MJ, Oh S, Lip GY. Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: a nationwide population-based study. PLoS One. 2017; 12:e0189495.

35. Ellis CR, Kaiser DW. The clinical efficacy of dabigatran etexilate for preventing stroke in atrial fibrillation patients. Vasc Health Risk Manag. 2013; 9:341–52.