Adherence to combination antithrombotic therapy in atrial fibrillation patients post-PCI

Abstract

Objective: Up to 30% of patients with atrial fibrillation (AF) also have coronary artery disease (CAD), with many undergoing percutaneous coronary intervention (PCI) for revascularization. These patients require combination antithrombotic therapy (ATT) with antiplatelet agent(s) of variable durations and an oral anticoagulant (OAC), which may require dose adjustment. The complexity of these regimens may contribute to misunderstandings for clinicians and patients alike. Any resulting non-adherence increases the risk of thrombosis and/or bleeding. This project aimed to describe patient experiences with ATT, including unplanned modifications, after discharge from University Health Network (UHN). Methods: This was an observational study with prospective follow-up. Eligible patients were those with documented AF requiring OAC who received a PCI and were discharged from UHN with a plan for combination ATT. Patients were identified from inpatient cardiology units and the coronary catheterization lab. Follow-up contact was planned at one-month, 3-months, 6-months, and 12-months post-PCI. Results: Thirty-two patients were enrolled. Follow-up one-month data was collected for 26 patients (81.3%), 3-month data for 17 patients (53.1%), and 6-month data for 10 patients (31.3%). A total of 12 patients reported at least one unplanned modification. Unplanned modifications occurred in nine patients(34.6%)at the one-month mark, six patients (35.3%) at the 3-month mark, and four patients (40%) at the 6-month mark. Nine of the 12 patients(75%)who reported modifications experienced a negative event that was either a reason for or was due to an unplanned modification to the ATT regimen. These events ranged from mild nosebleeds to ischemic stroke. Conclusion: Each patient’s experience with combination ATT is unique. Most patient-reported unplanned modifications appeared to be prescriber-driven. The risk of negative events both requiring and resulting from these modifications exists and occurred in 3 in 4patients. Understanding the patient experience is critical to improving discharge processes, transfer of information, and patient education to optimize patient outcomes.