EHRA survey: management of ACS in patients with Afib

  • Lane DA & al.
  • Europace
  • 14 Mar 2019

  • curated by Pavankumar Kamat
  • UK Clinical Digest
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Takeaway

  • Findings from the European Heart Rhythm Association (EHRA) survey suggest that the management of acute coronary syndrome (ACS) in patients with atrial fibrillation (Afib) is generally in accordance with the available guidelines.

Why this matters

  • A joint consensus document on the management of antithrombotic therapy in patients with Afib presenting with ACS and/or undergoing percutaneous coronary intervention (PCI) was published in 2014.
  • Since then new evidence has emerged, additional guidance has been issued and the use of non-vitamin K antagonist oral anticoagulants (NOACs) has increased.
  • Hence, there is a need to understand the current management of ACS in patients with Afib in Europe before the new consensus document is launched.

Study design

  • A questionnaire survey was conducted with 47 hospitals across Europe using the EHRA electrophysiology research network, of which 70.2% were university hospitals, 19.2% were non-university hospitals and 10.6% were private hospitals.
  • Funding: None disclosed.

Key results

  • Many centres are increasingly performing a primary PCI without interruption of NOACs in patients with ST-segment elevation myocardial infarction (67.4%) as opposed to those would temporarily discontinue NOACs before PCI (32.6%).
  • Majority of centres (57.8-62.2%) would use triple therapy for a shorter duration (4 weeks) in patients at high risk for stroke and bleeding, while a small proportion (15.6%) would continue triple therapy for a longer duration.
  • Among those with a low risk for stroke and bleeding, the majority of centres (56%) would continue triple therapy for 6 months.
  • On completion on the initial period of either dual or triple therapy, 75.6% of centres would continue dual therapy until 12 months after PCI, oral anticoagulant (vitamin K antagonist or NOAC) + clopidogrel being the most common choice.

Limitations

  • Low overall response rate.
  • As the majority of responders were from university hospitals, results may not reflect current clinical practice in Europe.

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