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KMID : 0368120110410100578
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Korean Circulation Journal
2011 Volume.41 No. 10 p.578 ~ p.582
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Optimal Antithrombotic Strategy in Patients With Atrial Fibrillation After Coronary Stent Implantation
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Jang Sung-Won
Rho Tai-Ho
Kim Dong-Bin
Cho Eun-Ju
Kwon Bum-June
Park Hun-Jun
Shin Woo-Seung
Kim Ji-Hoon
Lee Jong-Min
Moon Keon-Woong
Oh Yong-Seog
Yoo Ki-Dong
Youn Ho-Joong
Lee Man-Young
Chung Wook-Sung
Seung Ki-Bae
Kim Jae-Hyung
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Abstract
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Background and Objectives : Little evidence is available on the optimal antithrombotic therapy following percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF). We investigated the outcomes of antithrombotic treatment strategies in AF patients who underwent PCI.
Subjects and Methods : Three hundred sixty-two patients (68.0% men, mean age: 68.3±7.8 years) with AF and who had undergone PCI with stent implantation between 2005 and 2007 were enrolled. The clinical, demographic and procedural characteristics were reviewed and the stroke risk factors as well as antithrombotic regimens were analyzed.
Results: The accompanying comorbidities were as follows: hypertension (59.4%), diabetes (37.3%) and congestive heart failure (16.6%). The average number of stroke risk factors was 1.6. At the time of discharge after PCI, warfarin was prescribed for 84 patients (23.2%). Cilostazol was used in addition to dual antiplatelet therapy in 35% of the patients who did not receive warfarin. The mean follow-up period was 615±385 days. The incidences of major adverse cardiac events (MACE), stroke and major bleeding were 11.3%, 3.6% and 4.1%, respectively. By Kaplan-Meier survival analysis, warfarin treatment was not associated with a lower risk of MACE (p=0.886), but it was associated with an increased risk of major bleeding (p=0.002).
Conclusion: Oral anticoagulation therapy after PCI may increase hemorrhagic events in Korean AF patients.
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KEYWORD
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Atrial fibrillation, Angioplasty, Stents, Anticoagulants, Platelet aggregation inhibitors
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