Current status of anti-thrombotic therapy in patients with atrial fibrillation undergoing PCI. Results of the prospective RIVA-PCI Registry.

Objective A combination therapy with oral anticoagulation and antiplatelet therapy is recommended in patients with atrial fibrillation undergoing percutaneous coronary intervention. Little is known about the current status of antithrombotic regimens in clinical practice in Germany.

Material and Methods We performed a prospective registry in 51 hospital in Germany and included patients with atrial fibrillation treated with PCI with coronary stent implantation. Baseline characteristics, procedural informations, in-hospital events and antithrombotic regimens at discharge were collected and centrally analysed.

Results Between 01/2018 and 01/2020 a total of 1636 patients with atrial fibrillation were included in the registry. The indications for PCI were: elective 52 %, unstable Angina 18 %, NSTEMI 21 % and STEMI 9 %. At discharge aspirin was prescribed in 32 %, clopidogrel in 94 %, prasugrel in 1 % and ticagrelor in 3 %. A dual antithrombotic regimen consisting of oral anticoagulation and a P2Y12 inhibitor was given 72 %, triple therapy in 26 % and a monotherapy in 2 % of patients. The figure shows the distribution of the different antithrombotic regimens, with rivaroxaban as the most often used NOAC. Until discharge bleeding occurred in 2.9 %, while stent thrombosis, stroke and MI were reported in 0,2 %, 0.2 % and 0.1 %, respectvely.

Conclusion Dual therapy with a NOAC and clopidogrel is the preferred antithrombotic strategy in patients with atrial fibrillation undergoing PCI. However, recommended treatment regimens for 12-month follow-up vary with dual therapy for 6 months given most often. The in-hospital complication rate after PCI in patients with atrial fibrillation rate is low.

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Publication History

Article published online:
18 June 2021