# Management of Antithrombotic Therapy in Patients With Coexisting Atrial Fibrillation and Coronary Artery Disease Who Underwent Percutaneous Coronary Intervention Within the Last Year

## TL;DR

This study examines antithrombotic therapy patterns in patients with atrial fibrillation and coronary artery disease who had a recent heart procedure, finding factors that influence medication prescriptions.

## Contribution

The study provides new insights into antithrombotic drug utilization patterns and identifies factors affecting prescription rates in a specific high-risk patient group.

## Key findings

- Comorbidity burden and antiplatelet treatment were associated with lower anticoagulant prescription rates.
- OAC therapy without antiplatelet agents was linked to higher rehospitalization rates for cardiovascular events.
- Significant differences in antithrombotic therapy were observed based on the timing of PCI.

## Abstract

Coronary artery disease (CAD) is a common comorbidity in patients with atrial fibrillation (AF), and optimal antithrombotic medication improves clinical outcomes in this high‐risk population. The aim of our study was to describe antithrombotic drug regimens in different patient cohorts.

We investigated data from the prospective Helios Heart registry (H2) and the Heart Center Leipzig routine clinical database (HZL). We included inpatient cases with AF and CAD (hospitalized from March 2021 to July 2024 [H2] or January 2017 to December 2021 [HZL]), who underwent percutaneous coronary intervention (PCI) within the last 12 months. Information on clinical characteristics, coronary interventions, and medication prescribed was obtained from electronic case report forms and/or administrative data based on ICD‐10, OPS, and ATC codes.

We included 3481 (HZL), and 205 (H2) index cases with comparable baseline characteristics. Overall, 92.5% (HZL) and 87.6% (H2) of patients were on any anticoagulation, and 93.0% (HZL) and 80.2% (H2) were prescribed ≥ 1 antiplatelet agent. There were relevant differences in antithrombotic therapy when stratifying for PCI timing. Factors associated with higher (older age) or lower (comorbidity burden, antiplatelet treatment, prior left atrial appendage occlusion) prescription rates of OAC were identified. OAC therapy without adjunctive antiplatelet therapy was associated with an increased rate of rehospitalization for major adverse cardiovascular events at 12 months (HZL).

We presented current data on antithrombotic drug utilization in patients with AF and CAD and found comorbidity burden, concomitant antiplatelet treatment and other factors to be associated with lower anticoagulant prescription rates.

This study analyzed two high‐quality clinical databases comprising 205 and 3481 patients with atrial fibrillation and coronary artery disease who underwent percutaneous coronary intervention within the last 12 months. We described treatment patterns of antithrombotic drug therapy and identified factors that were associated with such medication.