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Long-term antithrombotic therapy after coronary artery bypass grafting in patients with preoperative atrial fibrillation: A nationwide observational study from the SWEDEHEART registry

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Název: Long-term antithrombotic therapy after coronary artery bypass grafting in patients with preoperative atrial fibrillation: A nationwide observational study from the SWEDEHEART registry
Autoři: Skibniewski, Mikolaj, Venetsanos, Dimitrios, Ahlsson, Anders, Batra, Gorav, Friberg, Örjan, Hofmann, Robin, Janzon, Magnus, Karlsson, Lars O., Sederholm Lawesson, Sofia, Nielsen, Susanne J., Jeppsson, Anders, Alfredsson, Joakim
Zdroj: American Heart Journal. 257:69-77
Témata: Antithrombotic therapy, Atrial fibrillation, CABG, Oral anticoagulation, Platelet inhibition
Popis: AIMS: To provide data guiding long-term antithrombotic therapy after coronary artery by-pass grafting (CABG) in patients with preoperative atrial fibrillation (AF).METHODS AND RESULTS: From the SWEDEHEART registry, we included all patients, between January 2006 and September 2016, with preoperative AF and CHA2DS2-VASC score ≥2, undergoing CABG. Based on dispensed prescriptions 12-18 months after CABG, patients were divided in three groups: platelet inhibitors (PI) only, oral anticoagulant (OAC) only or a combination of OAC + PI. Outcomes were: Major adverse cardiac and cerebrovascular events (MACCE, [all-cause death, myocardial infarction, or stroke]), net adverse clinical events (NACE, [MACCE or bleeding]) and the individual components of NACE. Inverse probability of treatment weighting was used to adjust for the non-randomized study design. Among 2,564 patients, 1,040 (41%) were treated with PI alone, 1,064 (41%) with OAC alone, and 460 (18%) with PI+OAC. Treatment with PI alone was associated with higher risk for MACCE (adjusted HR 1.43, 95% CI 1.09- 1.88), driven by higher risk for stroke and MI, compared to OAC alone. Treatment with PI+OAC, was associated with higher risk for NACE (adjusted HR 1.40, 95% CI 1.06-1.85), driven by higher risk for bleeds, compared to OAC alone.CONCLUSION: In this real-world observational study, a high proportion of patients with AF, undergoing CABG, did not receive long-term OAC therapy. Treatment with OAC alone was associated with a net clinical benefit, compared with PI alone or PI + OAC.
Popis souboru: electronic
Přístupová URL adresa: https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-491402
https://doi.org/10.1016/j.ahj.2022.12.001
Databáze: SwePub
Popis
Abstrakt:<strong>AIMS:</strong> To provide data guiding long-term antithrombotic therapy after coronary artery by-pass grafting (CABG) in patients with preoperative atrial fibrillation (AF).<strong>METHODS AND RESULTS:</strong> From the SWEDEHEART registry, we included all patients, between January 2006 and September 2016, with preoperative AF and CHA2DS2-VASC score ≥2, undergoing CABG. Based on dispensed prescriptions 12-18 months after CABG, patients were divided in three groups: platelet inhibitors (PI) only, oral anticoagulant (OAC) only or a combination of OAC + PI. Outcomes were: Major adverse cardiac and cerebrovascular events (MACCE, [all-cause death, myocardial infarction, or stroke]), net adverse clinical events (NACE, [MACCE or bleeding]) and the individual components of NACE. Inverse probability of treatment weighting was used to adjust for the non-randomized study design. Among 2,564 patients, 1,040 (41%) were treated with PI alone, 1,064 (41%) with OAC alone, and 460 (18%) with PI+OAC. Treatment with PI alone was associated with higher risk for MACCE (adjusted HR 1.43, 95% CI 1.09- 1.88), driven by higher risk for stroke and MI, compared to OAC alone. Treatment with PI+OAC, was associated with higher risk for NACE (adjusted HR 1.40, 95% CI 1.06-1.85), driven by higher risk for bleeds, compared to OAC alone.<strong>CONCLUSION:</strong> In this real-world observational study, a high proportion of patients with AF, undergoing CABG, did not receive long-term OAC therapy. Treatment with OAC alone was associated with a net clinical benefit, compared with PI alone or PI + OAC.
ISSN:00028703
10976744
DOI:10.1016/j.ahj.2022.12.001