PT  - JOURNAL ARTICLE
AU  - Leonardo De Luca
AU  - Andrea Rubboli
AU  - Leonardo Bolognese
AU  - Lucio Gonzini
AU  - Stefano Urbinati
AU  - Adriano Murrone
AU  - Fortunato Scotto di Uccio
AU  - Fabio Ferrari
AU  - Fabiana Lucà
AU  - Pasquale Caldarola
AU  - Donata Lucci
AU  - Domenico Gabrielli
AU  - Andrea Di Lenarda
AU  - Michele Massimo Gulizia
ED  - ,
TI  - Antithrombotic management of patients with acute coronary syndrome and atrial fibrillation undergoing coronary stenting: a prospective, observational, nationwide study
AID  - 10.1136/bmjopen-2020-041044
DP  - 2020 Dec 01
TA  - BMJ Open
PG  - e041044
VI  - 10
IP  - 12
4099  - http://bmjopen.bmj.com/content/10/12/e041044.short
4100  - http://bmjopen.bmj.com/content/10/12/e041044.full
SO  - BMJ Open2020 Dec 01; 10
AB  - Objective The aim of the study was to assess current management of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) undergoing coronary stenting.Design Non-interventional, prospective, nationwide study.Setting 76 private or public cardiology centres in Italy.Participants Patients with ACS with concomitant AF undergoing percutaneous coronary intervention (PCI).Primary and secondary outcome measures To obtain accurate and up-to-date information on pharmacological management of patients with AF admitted for an ACS and undergoing PCI with stent implantation.Results Over a 12-month period, 598 consecutive patients were enrolled: 48.8% with AF at hospital admission and 51.2% developing AF during hospitalisation. At discharge, a triple antithrombotic therapy (TAT) was prescribed in 64.8%, dual antiplatelet therapy (DAPT) in 25.7% and dual antithrombotic therapy (DAT) in 8.8% of patients. Among patients with AF at admission, TAT and DAT were more frequently prescribed compared with patients with new-onset AF (76.3% vs 53.8% and 12.5% vs 5.3%, respectively; both p<0.0001), while a DAPT was less often used (11.2% vs 39.5%; p<0.0001). At multivariable analysis, a major bleeding event (OR: 5.40; 95% CI: 2.42 to 12.05; p<0.0001) and malignancy (OR: 5.11; 95% CI: 1.77 to 14.78; p=0.003) resulted the most important independent predictors of DAT prescription.Conclusions In this contemporary registry of patients with ACS with AF treated with coronary stents, TAT still resulted as the antithrombotic strategy of choice, DAT was reserved for high bleeding risk and DAPT was mainly prescribed in those developing AF during hospitalisation.Trial registration number NCT03656523.