A prospective interventional registry of short-term dual-antiplatelet treatment after implantation of drug-eluting stents in patients with atrial fibrillation requiring oral anticoagulation therapy

  • Kazunori HorieEmail author
  • Takashi Matsumoto
  • Yukiko Mizutani
  • Norio Tada
  • Norichika Osai
  • Tsuyoshi Isawa
  • Masataka Taguri
  • Shigeaki Kato
  • Taku Honda
  • Tatsushi Ootomo
  • Naoto Inoue
Original Article


There are limited data regarding the use of antithrombotic therapy in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES). In this prospective interventional study, we evaluated the feasibility of short-term dual-antiplatelet therapy (DAPT) after DES implantation in AF patients treated with oral anticoagulation (OAC). The antithrombotic regimen in the present study was 1-month DAPT, followed by single-antiplatelet therapy with OAC. A total of 285 consecutive patients were enrolled between 2015 and 2017. The mean CHA2DS2-VASc score was 3.91 ± 1.51. The duration of DAPT was 28.5 ± 11.5 days. At 1-year follow-up, serious bleeding complications, defined as Bleeding Academic Research Consortium type ≥ 2, were observed in 27 patients (9.5%). Multivariate analysis showed that previous history of bleeding episodes (P = 0.009) and continuation of aspirin (P = 0.003) were independent predictors for the serious bleeding complications. High ORBIT (P = 0.008) and PRECISE-DAPT (P = 0.002) scores were associated with the bleeding complications, and the cut-off values were 5.00 and 49.0, respectively. No definite stent thrombosis occurred in any of the patients. Short-term DAPT is feasible in AF patients treated with OAC after undergoing PCI with DES. The previous history of bleeding episodes and long-term aspirin use were associated with their 1-year serious bleeding events.


Atrial fibrillation Drug-eluting stents Oral anticoagulation Antiplatelet therapy Percutaneous coronary intervention 



The authors are grateful to Manami Kumagai, Ai Saito, Shizuka Ito, and Saori Ichijo for their support in data collection and analysis of the catheterization findings.


The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


  1. 1.
    Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893–962.CrossRefGoogle Scholar
  2. 2.
    Hansen ML, Sørensen R, Clausen MT, Fog-Petersen ML, Raunsø J, Gadsbøll N, et al. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med. 2010;170:1433–41.CrossRefGoogle Scholar
  3. 3.
    Daida H, Miyauchi K, Ogawa H, Yokoi H, Matsumoto M, Kitakaze M, et al. Management and 2-year long-term clinical outcome of acute coronary syndrome in Japan: prevention of atherothrombotic incidents following ischemic coronary attack (PACIFIC) registry. Circ J. 2013;77:934–43.CrossRefGoogle Scholar
  4. 4.
    Ishihara M, Fujino M, Ogawa H, Yasuda S, Noguchi T, Nakao K, et al. Clinical presentation, management and outcome of japanese patients with acute myocardial infarction in the troponin era—Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET). Circ J. 2015;79:1255–62.CrossRefGoogle Scholar
  5. 5.
    Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39:213–60.CrossRefGoogle Scholar
  6. 6.
    Dewilde WJ, Oirbans T, Verheugt FW, Kelder JC, De Smet BJ, Herrman JP, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013;381:1107–15.CrossRefGoogle Scholar
  7. 7.
    Gibson CM, Mehran R, Bode C, Halperin J, Verheugt FW, Wildgoose P, et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med. 2016;375:2423–34.CrossRefGoogle Scholar
  8. 8.
    Cannon CP, Bhatt DL, Oldgren J, Lip GYH, Ellis SG, Kimura T, et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med. 2017;377:1513–24.CrossRefGoogle Scholar
  9. 9.
    Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R, et al. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med. 2019;17:1. Scholar
  10. 10.
    Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–100.CrossRefGoogle Scholar
  11. 11.
    O’Brien EC, Simon DN, Thomas LE, Hylek EM, Gersh BJ, Ansell JE, et al. The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J. 2015;36:3258–64.Google Scholar
  12. 12.
    Costa F, van Klaveren D, James S, Heg D, Räber L, Feres F, et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017;389:1025–34.CrossRefGoogle Scholar
  13. 13.
    Baber U, Mehran R, Giustino G, Cohen DJ, Henry TD, Sartori S, et al. Coronary thrombosis and major bleeding after PCI with drug-eluting stents: risk scores from PARIS. J Am Coll Cardiol. 2016;67:2224–34.CrossRefGoogle Scholar
  14. 14.
    Saito S, Isshiki T, Kimura T, Ogawa H, Yokoi H, Nanto S, et al. Efficacy and safety of adjusted-dose prasugrel compared with clopidogrel in Japanese patients with acute coronary syndrome: the PRASFIT-ACS study. Circ J. 2014;78:1684–92.CrossRefGoogle Scholar
  15. 15.
    JCS Joint Working Group. Guidelines for pharmacotherapy of atrial fibrillation (JCS2013). Circ J. 2014;78:1997–2021.CrossRefGoogle Scholar
  16. 16.
    Okumura K, Hori M, Tanahashi N, John Camm A. Special considerations for therapeutic choice of non-vitamin K antagonist oral anticoagulants for Japanese patients with nonvalvular atrial fibrillation. Clin Cardiol. 2017;40:126–31.CrossRefGoogle Scholar
  17. 17.
    Horie K, Tada N, Isawa T, Matsumoto T, Taguri M, Kato S, et al. A randomized comparison of incidence of radial artery occlusion and symptomatic radial artery spasm associated with elective transradial coronary intervention using 6.5-Fr sheathless eaucath guiding catheter vs 6.0-Fr glidesheath slender. EuroIntervention. 2018;13:2018–25.CrossRefGoogle Scholar
  18. 18.
    Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123:2736–47.CrossRefGoogle Scholar
  19. 19.
    Suh JW, Mehran R, Claessen BE, Xu K, Baber U, Dangas G, et al. Impact of in-hospital major bleeding on late clinical outcomes after primary percutaneous coronary intervention in acute myocardial infarction the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. J Am Coll Cardiol. 2011;58:1750–6.CrossRefGoogle Scholar
  20. 20.
    Larici AR, Franchi P, Occhipinti M, Contegiacomo A, del Ciello A, Calandriello L, et al. Diagnosis and management of hemoptysis. Diagn Interv Radiol. 2014;20:299–309.CrossRefGoogle Scholar
  21. 21.
    CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1329–39.CrossRefGoogle Scholar
  22. 22.
    Park TK, Song YB, Ahn J, Carriere KC, Hahn JY, Yang JH, et al. Clopidogrel versus aspirin as an antiplatelet monotherapy after 12-month dual-antiplatelet therapy in the era of drug-eluting stents. Circ Cardiovasc Interv. 2016;9:e002816.CrossRefGoogle Scholar
  23. 23.
    Reddy VY, Doshi SK, Kar S, Gibson DN, Price MJ, Huber K, et al. 5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials. J Am Coll Cardiol. 2017;70:2964–75.CrossRefGoogle Scholar
  24. 24.
    Reddy VY, Möbius-Winkler S, Miller MA, Neuzil P, Schuler G, Wiebe J, et al. Left atrial appendage closure with the Watchman device in patients with a contraindication for oral anticoagulation: the ASAP study (ASA Plavix feasibility study with watchman left atrial appendage closure technology). J Am Coll Cardiol. 2013;61:2551–6.CrossRefGoogle Scholar
  25. 25.
    Natsuaki M, Morimoto T, Yamamoto E, Shiomi H, Furukawa Y, Abe M, et al. 1-year outcome of a prospective trial stopping dual antiplatelet therapy at 3 months after everolimus-eluting cobalt-chromium stent implantation: ShortT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent (STOPDAPT) trial. A randomized multicenter trial. Cardiovasc Interv Ther. 2016;31:196–209.CrossRefGoogle Scholar
  26. 26.
    Jang JS, Song YJ, Kang W, Jin HY, Seo JS, Yang TH, et al. Intravascular ultrasound-guided implantation of drug-eluting stents to improve outcome: a meta-analysis. JACC Cardiovasc Interv. 2014;7:233–43.CrossRefGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2019

Authors and Affiliations

  • Kazunori Horie
    • 1
    Email author
  • Takashi Matsumoto
    • 1
  • Yukiko Mizutani
    • 1
  • Norio Tada
    • 1
  • Norichika Osai
    • 1
  • Tsuyoshi Isawa
    • 1
  • Masataka Taguri
    • 2
  • Shigeaki Kato
    • 1
  • Taku Honda
    • 1
  • Tatsushi Ootomo
    • 1
  • Naoto Inoue
    • 1
  1. 1.Division of Cardiovascular Medicine, Department of Cardiovascular MedicineSendai Kousei HospitalSendaiJapan
  2. 2.Department of BiostaticsYokohama City University School of MedicineYokohamaJapan

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