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Comparative Outcomes Of Peripheral Vascular Interventions In Patients With Atrial Fibrillation Discharged On Anticoagulation In Combination With Aspirin Or P2Y12 Inhibitors
Shreef Said, M.D, Dana Alameddine, Uday Dhanda, Isibor Arhuidese, Uwe Fischer, Hannah Zwibelman, Alan Dardik, Cassius Iyad Ochoa Chaar.
Yale University, School of Medicine, New haven, CT, USA.
OBJECTIVES:Atrial fibrillation (AF) affects 15% of patients undergoing peripheral vascular interventions (PVI) and frequently requires anticoagulation (AC). Recent guidelines suggested adding single antiplatelet therapy to AC for patients with AF after PVI without specifying the type of antiplatelet therapy. This study compares the addition of aspirin or P2Y12 inhibitors (P2Y12i) to AC after PVI in patients with AF.
METHODS:The Vascular Quality initiative (VQI) PVI files were reviewed. Only patients undergoing PVI with AF were included. The characteristics and outcomes of patients discharged on AC+aspirin were compared to those discharged on AC+P2Y12i.
RESULTS:A total of 17,478 patients with AF underwent PVI for PAD. There were extensive variations in antithrombotic discharge regimen with AC + single antiplatelet therapy (SAPT) used in 45.5% of patients followed by dual antiplatelets (DAPT) without AC (20%) and AC+DAPT (12%). Only 9.7% were discharged on AC without antiplatelet therapy. In 7,959 patients treated with AC+SAPT, 51% (N=4,023) were discharged on AC+P2Y12i (98% received clopidogrel) and the remaining received AC+aspirin. There were no differences in demographics and comorbidities between both groups. Patients discharged on AC+P2Y12i had higher rates of prior lower extremity revascularization (LER) and prior percutaneous coronary intervention (PCI) compared to patients discharged on AC+aspirin. (Table) Patients receiving AC+P2Y12i were more likely to undergo stenting compared to those receiving AC+aspirin, with no differences in indications between the two groups. Patients receiving AC+P2Y12i had higher rates of technical success and were more likely to be discharged home compared to the AC+aspirin group. Kaplan-Meier curves for mortality, reintervention, amputation, and major adverse limb event (MALE)-free survival demonstrated no significant difference between both groups. Cox regression demonstrated that prior LER was associated with increased hazards of MALE (HR=1.15[1.02-1.30]), whereas prior PCI was associated with mortality (HR=1.12[1.02-1.22]) but antithrombotic regimens were not associated with outcomes.
CONCLUSIONS:In patients with AF undergoing PVI, the addition of aspirin or P2Y12i to AC at discharge did not affect outcomes. The findings of this study provide a significant opportunity for economic savings as the cost of P2Y12i is more than 100-fold that of aspirin. Prospective studies in comparative effectiveness of antithrombic therapy in PAD are needed.
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