Changes in prescribing antithrombotic therapy in patients with atrial fibrillation and myocardial infarction in 2016-2019

Aim. To study the changes in prescribing antithrombotic therapy (ATT) among patients with myocardial infarction (MI) and atrial fibrillation (AF), hospitalized in a cardiology hospital in 2016-2017 and 2018-2019.

Material and methods. The study included 362 patients with MI and AF in 20162017 — 106 patients, of which 104 were included in the analysis, in 2018-2019 — 256 patients. The median age of patients hospitalized in 2016-2017 was 70,0 (61,0; 78,0) years, in 2018-2019 — 71 (65,0; 79,3) years (p=0,09). There were 60 men (55,6%) in 2016-2017 and 143 (55,8%) in 2018-2019 (p=0,90).

Results. In 2016-2017, 80 (76,9%) patients were prescribed dual antiplatelet therapy (DAPT), 17 (16,3%) — therapy with oral anticoagulants (OAC), while 7 (6,7%) of them were as part of triple ATT, 9 (8,7%) — as part of dual ATT (OAC+antiplatelet agent), and 1 (1,0%) — as monotherapy.

In 2018-2019, 97 (37, 9%) patients were prescribed DAPT, 140 (54,7%) — OAC therapy, while 115 (44,9%) of them were as part of triple ATT 25 (9,8%) — as a part of dual ATT (OAC+antiplatelet agent). Among all cases of OAC prescription in 2016-2017 and 2018-2019, warfarin was prescribed in 11 (64,7%) and 51 (36,4%) patients,respectively (p=0,02), while rivaroxaban — in 6 (35,3%) and 88 (62,9%) patients, respectively (p=0,03). In 2018-2019, one patient was prescribed dabigatran etexilate.

Conclusion. The study revealed that the prescription rate of triple ATT at discharge in 2018-2019 increased 6,7 times compared to 2016-2017 and amounted to 44,9% (n=115) (p<0,001). The prescription rate of OAC in 2018-2019 also increased 3,4 times compared to 2016-2017 and amounted to 54,7% (n=140) (p<0,001).

1. Federal state statistics service. Rosstat has presented an updated demographic forecast until 2036. (In Russ.) https://www.gks.ru/folder/313/document/72529 (8 May 2020).

2. Konstantinova EV, Balayan NM, Shostak NA. Myocardial infarction in young people: causes and prognosis of the disease. Klinicist. 2017;11(1):10-5. (In Russ.) doi:10.17650/1818-8338-2016-10-4-10-15.

3. Boytsov SA, Pogosova NV, Bubnova MG, et al. Cardiovascular prevention 2017. The Russian national recommendations. Russian Journal of Cardiology. 2018;23(6):7-122. (In Russ.) doi.10.15829/1560-4071-2018-6-7-122.

4. Bunin YuA, Miklishanskaya SV, Chigineva VV, Zolozova EA. Atrial fibrillation and ventricular arrhythmias in ST-segment elevation myocardial infarction: possibilities of pharmacotherapy and non-drug treatment. Racional'naya Farmakoterapiya v Kardiologii. 2018;14(4):605-11. (In Russ.) doi:10.20996/1819-6446-2018-14-4-605-611.

5. Eniseeva ES. Double and triple antithrombotic therapy for atrial fibrillation and acute coronary syndrome. Sibirskii medicinskii zhurnal (Irkutsk). 2016;2:18-22. (In Russ.)

6. Venkatesh R, Priyanjali P, Aviral V, et al. Meta-analysis comparing double versus Triple Anti-thrombotic Therapy in Patients with Atrial Fibrillation and Coronary Artery Disease. Am J Cardiol. 2020;125(1):19-28. doi:10.1016/j.amjcard.2019.09.045.

7. Lopes RD, Heizer G, Aronson R, et al. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. N Engl J Med. 2019;380:1509-24. doi:10.1056/NEJMoa1817083.

8. Baturina OA, Andreev DA, Ananicheva NA, et al. Prevalence of Atrial Fibrillation and use of Oral Antithrombotic Therapy in Patients with Acute Coronary Syndrome. Kardiologiia. 2019;59( 1):40-8. (In Russ.) doi:10.18087/cardio.2019.1.10213.

9. Pereverzeva KG, Yakushin SS, Pripadcheva AE, et al. Antithrombotic therapy in patients with atrial fibrillation after myocardial infarction: clinical recommendations and real practice. Rational Pharmacotherapy in Cardiology. 2018;14(6):858-63. (In Russ.) doi:10.20996/1819-6446-2018-14-6-858-863.

10. Dalgaard F, Pieper K, Verheugt F, et al. GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation study BMJ Open. 2019;9:e033283. doi.10.1136/bmjopen-2019-033283.

11. The Federal law “on amendments to article 40 of the Federal law “on mandatory medical insurance in the Russian Federation” and the Federal law “on the basics of public health protection in the Russian Federation” on clinical recommendations” dated 25.12.2018 N 489-FZ (the latest version). (In Russ.) http://www.consultant.ru/document/cons_doc_LAW_314269/

12. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Russian Journal of Cardiology. 2018;23(5):103-58. (In Russ.) doi:10.15829/1560-4071-2018-5-103-158.

13. Baranova EI. New safety standards for anticoagulant therapy in atrial fibrillation. Russian Journal of Cardiology. 2018;23( 10): 136-44. (In Russ.) doi:10.15829/1560-4071-2018-10-136-144.

14. Tatarintseva ZG, Kosmacheva ED, Kruchinova SV, et al. Antiplatelet therapy in patients with atrial fibrillation against the background of acute coronary syndrome in real clinical practice (according to the total register of acute coronary syndrome in the Krasnodar territory) Kardiologiya: novosti, mneniya, obuchenie. 2018;6(4):6-13. (In Russ.) doi:10.24411/2309-1908-2018-14001.