Cross-sectional Investigation Of Antithrombotic Strategy In Atrial Fibrillation Patients Occurred Acute Coronary Syndrome And Undergone Percutaneous Coronary Intervention In Beijing

Objective: To analyze current situation of antithrombotic strategy in atrial fibrillation(AF)patients occurred acute coronary syndrome(ACS)and undergone percutaneous coronary intervention(PCI)in Beijing.Methods: 2439 AF patients occurred ACS and undergone PCI were collected in 12 tertiary hospitals in Beijing from 2010-01-01 to 2014-12-31.The patients were Followed up to 2016 April.According to CHA2DS2-VASc and HAS-BLED scoring standard,The patients were divided into 4 groups: low thromboembolism/stroke and low bleeding risk group(CHA2DS2-VASc?1 HAS-BLED?2 n=499);low thromboembolism/stroke and high bleeding risk group(CHA2DS2-VASc?1 HAS-BLED?3 n=11);high thromboembolism/stroke and low bleeding risk group(CHA2DS2-VASc?2HAS-BLED?2 n=1443);high thromboembolism/stroke and high bleeding risk group(CHA2DS2-VASc?2 HAS-BLED?3 n=486).To compare different antithrombotic therapy whether there were differences of adverse events between four groups after discharged.Antithrombotic therapy options include: aspirin + clopidogrel +warfarin therapy(Triple Antithrombotic Therapy,TT),aspirin + P2Y12 receptor antagonists(clopidogrel or ticagrelor)(Dual Antiplatelet Therapy,DAPT),warfarin+aspirin or clopidogrel therapy(warfarin +Single antiplatelet therapy).Adverse events include: all-cause death,major adverse cardiovascular and cerebrovascular events,bleeding events.Results: In all 2439 patients after discharged,the total BARC bleeding(?2=13.891,P=0.001),massive hemorrhage of BARC(Fisher's exact test=9.634,P=0.008),BARC3c(Fisher's exact test=8.845,P=0.016),BARC 5b(Fisher's exact test=7.401,P=0.034)had statistical significance among the 3 antithrombotic therapies.DAPT and warfarin +Single antiplatelet had statistical significance on total BARC bleeding after pairwise comparison.After combination of TT and warfarin +Single antiplatelet(warfarin was used),compared with DAPT(warfarin was not used): the total BARC bleeding(?2 =7.186,P=0.007),massive hemorrhage of BARC(?2 =6.194,P=0.013),BARC 3c(Fisher's exact test,P=0.024)had statistical significance between the 2 antithrombotic therapies.In the 486 patients that CHA2DS2-VASc?2 and HAS-BLED?3 after discharged,the total BARC bleeding(Fisher's exact test =7.312,P=0.019),massive hemorrhage of BARC(Fisher's exact test=7.195,P=0.028),BARC 3c(Fisher's exact test=9.424,P=0.014)had statistical significance among the 3 antithrombotic therapies.After combination of TT and warfarin +Single antiplatelet(warfarin was used),compared with DAPT(warfarin was not used): the BARC 3c(Fisher's exact test,P=0.048)had statistical significance between the 2 antithrombotic therapies.Conclusion: AF patients occurred ACS and undergone PCI taking antiplatelet drugs and warfarin for anticoagulation will increase bleeding risk,and there is no statistical difference on all-cause mortality and ischemic events whether adding warfarin.