Treatment Pattern of Antithrombotic Therapy over Time after Percutaneous Coronary Intervention in Patients with Atrial Fibrillation in Real-World Practice in Korea
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Population
2.3. Temporal Trends and Treatment Patterns
2.4. Treatment Duration
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Treatment Patterns and Temporal Trends
3.3. Treatment Duration
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Triple Therapy a (N = 1908) | Dual Therapy a (N = 266) | DAPT a (N = 4711) | OAC Monotherapy a (N = 13) | SAPT a (N = 851) | p-Value b | |
---|---|---|---|---|---|---|
Index treatment, % | ||||||
Warfarin | 94.5 | 97.7 | 0 | 92.3 | 0 | NA |
NOAC | 5.5 | 2.3 | 0 | 7.7 | 0 | NA |
Apixaban | 0.8 | 0.8 | 0 | 0 | 0 | NA |
Dabigatran | 2.3 | 0.8 | 0 | 7.7 | 0 | NA |
Rivaroxaban | 2.4 | 0.8 | 0 | 0 | 0 | NA |
Aspirin–clopidogrel | 97.2 | 0 | 94.1 | 0 | 0 | NA |
Aspirin–prasugrel | 0.5 | 0 | 1.0 | 0 | 0 | NA |
Aspirin–ticagrelor | 2.4 | 0 | 4.9 | 0 | 0 | NA |
Aspirin | 0 | 6.0 | 0 | 0 | 6.3 | NA |
Clopidogrel | 0 | 92.9 | 0 | 0 | 91.2 | NA |
Prasugrel | 0 | 0.4 | 0 | 0 | 0.6 | NA |
Ticagrelor | 0 | 0.8 | 0 | 0 | 1.9 | NA |
Age (years), mean | 70.7 | 69.0 | 70.3 | 68.9 | 69.7 | 0.0097 |
Female, % | 33.1 | 28.2 | 34.5 | 30.8 | 36.0 | 0.1525 |
Insurance, % | ||||||
NHI | 92.7 | 94.0 | 92.6 | 100.0 | 92.9 | 0.7763 |
Medical aid | 7.3 | 6.0 | 7.4 | 0.0 | 7.1 | |
CHA2DS2-VASc, mean | 4.6 | 4.1 | 4.2 | 4.6 | 4.1 | <0.0001 |
HAS-BLED, mean | 3.7 | 3.4 | 3.5 | 3.9 | 3.5 | <0.0001 |
CCI, mean | 4.1 | 3.6 | 3.7 | 3.8 | 3.5 | <0.0001 |
Medical history, % | ||||||
ACS | 65.6 | 58.3 | 70.5 | 38.5 | 65.9 | <0.0001 |
CHF | 44.9 | 33.1 | 36.1 | 46.2 | 26.8 | <0.0001 |
Hypertension | 91.6 | 92.5 | 92.2 | 92.3 | 92.7 | 0.8604 |
Diabetes | 64.4 | 66.2 | 60.8 | 53.8 | 63.8 | 0.027 |
Ischemic stroke | 34.1 | 29.3 | 19.2 | 53.8 | 20.6 | <0.0001 |
Systemic embolism | 4.4 | 5.3 | 2.9 | 7.7 | 3.8 | 0.0125 |
Vascular disease | 42.1 | 31.6 | 46.6 | 38.5 | 38.9 | <0.0001 |
Renal disease (CKD3/4) | 1.5 | 0.0 | 0.9 | 0.0 | 0.1 | 0.0053 |
Bleeding | 27.1 | 16.5 | 26.3 | 38.5 | 23.3 | 0.0012 |
Medication history, % | ||||||
NOACs | 3.6 | 1.1 | 1.4 | 0.0 | 0.8 | <0.0001 |
Warfarin | 49.8 | 53.8 | 9.4 | 69.2 | 12.0 | <0.0001 |
NSAIDs | 81.4 | 80.1 | 83.3 | 76.9 | 83.4 | 0.2617 |
Antiplatelets | 63.9 | 64.3 | 72.5 | 84.6 | 70.9 | <0.0001 |
Antiarrhythmics | 61.4 | 56.8 | 59.4 | 76.9 | 61.6 | 0.1971 |
Statins | 88.7 | 78.2 | 88.4 | 92.3 | 82.0 | <0.0001 |
Proton pump inhibitors | 44.3 | 30.1 | 42.6 | 38.5 | 28.4 | <0.0001 |
H2-receptor antagonists | 74.6 | 69.2 | 76.7 | 53.8 | 76.0 | 0.0095 |
Digoxin | 39.8 | 38.7 | 29.8 | 38.5 | 29.6 | <0.0001 |
N | % | Treatment Patterns | |
---|---|---|---|
Triple therapy group | 1908 | ||
1st | 440 | 23.1 | Triple therapy 12 months |
2nd | 218 | 11.4 | Triple therapy 1 month ⇒ DAPT 11 months |
3rd | 86 | 4.5 | Triple therapy 1 month ⇒ Dual therapy 11 months |
Triple therapy group ⇒ Dual therapy switcher | 611 | ||
1st | 86 | 14.1 | Triple therapy 1 month ⇒ Dual therapy 11 months |
2nd | 44 | 7.2 | Triple therapy 8 months ⇒ Dual therapy 4 months |
3rd | 41 | 6.7 | Triple therapy 7 months ⇒ Dual therapy 5 months |
DAPT group | 4711 | ||
1st | 2951 | 62.6 | DAPT 12 months |
2nd | 119 | 2.5 | DAPT 1 month ⇒ SAPT 11 months |
3rd | 55 | 1.2 | DAPT 11 months ⇒ SAPT 1 month |
Treatment Durations (Days) | ||||
---|---|---|---|---|
N | % | Mean (SE) | Median | |
Triple therapy group | 1908 | Treatment duration of triple therapy a | ||
Entire b | 1907 | 99.9 | 138.18 (3.17) | 81 |
ACS history b | 1251 | 65.6 | 141.39 (3.94) | 87 |
HAS-BLED ≥ 3 b | 1675 | 87.8 | 134.56 (3.37) | 75 |
IS/SE history | 703 | 36.8 | 122.93 (5.09) | 55 |
Female | 694 | 36.4 | 120.71 (5.09) | 47 |
Age ≥ 75 | 632 | 33.1 | 122.32 (5.3) | 56.5 |
Triple therapy group ⇒ Dual therapy switcher | 611 | Treatment duration of dual therapy a | ||
Entire | 611 | 100.0 | 162.57 (4.17) | 155 |
ACS history | 400 | 65.5 | 164.17 (5.21) | 149 |
HAS-BLED ≥ 3 | 541 | 88.5 | 162.53 (4.47) | 155 |
IS/SE history | 238 | 39.0 | 157.52 (6.99) | 131 |
Female | 230 | 37.6 | 160.49 (6.81) | 150.5 |
Age ≥ 75 | 205 | 33.6 | 157.49 (7.09) | 142 |
DAPT group | 4711 | Treatment duration of DAPT a | ||
Entire | 4711 | 100.0 | 261.75 (1.99) | 344 |
ACS history | 3321 | 70.5 | 262.37 (2.38) | 345 |
HAS-BLED ≥ 3 | 4015 | 85.2 | 258.21 (2.19) | 343 |
IS/SE history | 994 | 21.1 | 236.71 (4.63) | 324 |
Female | 1677 | 35.6 | 245.93 (3.49) | 334 |
Age ≥ 75 | 1627 | 34.5 | 256.58 (3.44) | 341 |
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Han, S.; Han, S.; Jang, S.-W.; Lee, M.-Y.; On, Y.-K.; Bang, O.Y.; Lee, J.-M.; Park, Y.-J.; Shin, J.-S.; Kang, S.; et al. Treatment Pattern of Antithrombotic Therapy over Time after Percutaneous Coronary Intervention in Patients with Atrial Fibrillation in Real-World Practice in Korea. Healthcare 2021, 9, 1185. https://doi.org/10.3390/healthcare9091185
Han S, Han S, Jang S-W, Lee M-Y, On Y-K, Bang OY, Lee J-M, Park Y-J, Shin J-S, Kang S, et al. Treatment Pattern of Antithrombotic Therapy over Time after Percutaneous Coronary Intervention in Patients with Atrial Fibrillation in Real-World Practice in Korea. Healthcare. 2021; 9(9):1185. https://doi.org/10.3390/healthcare9091185
Chicago/Turabian StyleHan, Seongwook, Sola Han, Sung-Won Jang, Myung-Yong Lee, Young-Keun On, Oh Young Bang, Ji-Min Lee, Yoo-Jung Park, Ji-Soo Shin, Seongsik Kang, and et al. 2021. "Treatment Pattern of Antithrombotic Therapy over Time after Percutaneous Coronary Intervention in Patients with Atrial Fibrillation in Real-World Practice in Korea" Healthcare 9, no. 9: 1185. https://doi.org/10.3390/healthcare9091185