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Purpose <p>Atrial fibrillation (AF) increases thromboembolic and cardiovascular risks. The optimal antithrombotic strategy for patients with AF receiving percutaneous coronary intervention (PCI) remains controversial owing to the competing risks of ischemia and bleeding. We hypothesized that non–vitamin K antagonist oral anticoagulant (NOAC)-based triple antithrombotic therapy (TAT) would provide superior ischemic protection than dual antiplatelet therapy (DAPT), without excessively increasing bleeding risk. This study compared the effectiveness and safety of NOAC-based triple antithrombotic therapy (TAT) with DAPT, in AF patients undergoing PCI.</p> Methods <p>Using the Health Insurance Review and Assessment database, we conducted a retrospective cohort study on patients with AF who underwent PCI between 2016 and 2021. Patients receiving NOAC-based TAT or DAPT were propensity score matched 1:1. The primary endpoint was a composite of ischemic stroke, myocardial infarction, revascularization, and all-cause mortality. Secondary outcomes included these endpoints individually and major bleeding events.</p> Results <p>After matching, 3,346 patients per group were enrolled. At 6-month follow-up, TAT was associated with a significantly lower risk of the composite outcome than DAPT (hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.68–0.92; <i>p</i> &lt; 0.01). TAT also reduced the risk of myocardial infarction (HR 0.79, 95% CI 0.62–1.00; <i>p</i> = 0.05), ischemic stroke (HR 0.69, 95% CI 0.48–0.99; <i>p</i> = 0.04), and in-hospital mortality (HR 0.64, 95% CI 0.48–0.87; <i>p</i> &lt; 0.01), with no significant increase in major bleeding (HR 0.91, 95% CI 0.65–1.27; <i>p</i> = 0.59).</p> Conclusion <p>NOAC-based TAT significantly reduced composite cardiovascular events without increasing bleeding risk, supporting its clinical utility in this population.</p>

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Comparative effectiveness and safety of non–vitamin K antagonist oral anticoagulant-based triple therapy versus dual antiplatelet therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention

  • 期刊论文

  • 发表日期：

    2026年1月19日

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  • Minhee Ku,
  • Yu Jeong Lee,
  • Nam Kyung Je

摘要

Purpose

Atrial fibrillation (AF) increases thromboembolic and cardiovascular risks. The optimal antithrombotic strategy for patients with AF receiving percutaneous coronary intervention (PCI) remains controversial owing to the competing risks of ischemia and bleeding. We hypothesized that non–vitamin K antagonist oral anticoagulant (NOAC)-based triple antithrombotic therapy (TAT) would provide superior ischemic protection than dual antiplatelet therapy (DAPT), without excessively increasing bleeding risk. This study compared the effectiveness and safety of NOAC-based triple antithrombotic therapy (TAT) with DAPT, in AF patients undergoing PCI.

Methods

Using the Health Insurance Review and Assessment database, we conducted a retrospective cohort study on patients with AF who underwent PCI between 2016 and 2021. Patients receiving NOAC-based TAT or DAPT were propensity score matched 1:1. The primary endpoint was a composite of ischemic stroke, myocardial infarction, revascularization, and all-cause mortality. Secondary outcomes included these endpoints individually and major bleeding events.

Results

After matching, 3,346 patients per group were enrolled. At 6-month follow-up, TAT was associated with a significantly lower risk of the composite outcome than DAPT (hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.68–0.92; p < 0.01). TAT also reduced the risk of myocardial infarction (HR 0.79, 95% CI 0.62–1.00; p = 0.05), ischemic stroke (HR 0.69, 95% CI 0.48–0.99; p = 0.04), and in-hospital mortality (HR 0.64, 95% CI 0.48–0.87; p < 0.01), with no significant increase in major bleeding (HR 0.91, 95% CI 0.65–1.27; p = 0.59).

Conclusion

NOAC-based TAT significantly reduced composite cardiovascular events without increasing bleeding risk, supporting its clinical utility in this population.