A survey on current status of antithrombotic therapy for patients with atrial fibrillation complicated by coronary artery disease

Huang Zhiqi; Chen Mulei; Zhang Xiao

doi:10.3969/j.issn.1674-4055.2018.11.24

Abstract：Objective To investigate retrospectively the current status of antithrombotic therapy for patients with atrial fibrillation (AF) complicated by coronary artery disease (CAD), and analyze the factors related to underuse of antithrombotics. Methods The patients (n=231) were chosen from Beijing Chaoyang Hospital affiliated to Capital University of Medical Sciences from Jan. 1, 2016 to Dec. 31, 2016. The patients were divided, according to CAD types, into AF+stable coronary artery disease group (AF+SCAD group, n=173) and AF+acute coronary syndrome group (AF+ACS group, n=58). And the patients were divided, according to bleeding risk, into high bleeding risk group (n=139) and low bleeding risk group (n=92). The clinical data and antithrombotic status were compared by using χ2test in all groups, and factors influencing standard antithrombotic therapy during hospitalization and factors induced underuse of antithrombotics after hospital discharge were analyzed by using multi-factor Logistic regression analysis. Results There were 104 patients (45.0%) with standard antithrombotic therapy during hospitalization, and only 66 (28.6%) with standard antithrombotic therapy after hospital discharge. The percentage of patients with antithrombotic therapy was significantly higher in AF+ACS group than that in AF+SCAD group (74.1% vs. 35.3%, P<0.01) during hospitalization. The percentage of patients with antithrombotic therapy was significantly lower in high bleeding risk group than that in low bleeding risk group (32.6% vs. 53.2%, P<0.01). The results of multi-factor Logistic analysis showed that complicating stroke (OR=2.427, 95%CI:1.16~5.077), complicating ACS (OR=8.111, 95%CI: 3.862~17.033) and HAS-BLED scores (OR=0.424, 95%CI:0.284~0.634) were factors influencing standard antithrombotic therapy during hospitalization (P<0.05). Paroxysmal atrial fibrillation (PAF, OR=3.536, 95%CI: 1.803~6.935), complicating ACS (OR=3.647, 95%CI: 1.514~8.783) and non-cardiologic patients (OR=3.62, 95%CI: 1.685~7.777) were independent factor influencing underuse of antithrombotics after hospital discharge (P<0.01). Conclusion There is substantial deviation from international guidelines in standard antithrombotic therapy use for AF+CAD patients in clinical practice, and bleeding risk, types of complicating CAD, complicating stroke, AF types, and hospital departments are independent factors influencing antithrombotic treatments.