To compare the safety and efficacy of dual antithrombotic therapy [DAT, non-vitamin K antagonist oral anticoagulant (NOAC) plus single antiplatelet] with triple antithrombotic therapy (TAT: NOAC plus dual antiplatelets) in patients with atrial fibrillation (AF) concomitant with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI).

A prospective, observational study was conducted in Fuwai Hospital between January, 2017 and December 2019.AF patients presenting with ACS or undergoing PCI, and receiving DAT or TAT with NOAC at discharge, were enrolled.The patients were followed up for 1 year.The secondary endpoint was a bleeding defined by thrombolysis in myocardial infarction (TIMI) bleeding classification.The primary efficacy endpoint was composite end point of death or embolism events.

Overall, 553 patients were included, 397 were male, and the mean age was (67.9±9.0) years old.At discharge, 254 received DAT and 299 received TAT.Compared to the patients receiving TAT, those receiving DAT were more elderly [(69.5±9.8) years old vs.(66.6±8.0) years old, P<0.001], less male (66.5% vs. 76.3%, P=0.011), higher CHA₂DS₂-VASc score (3.9±1.8 vs.3.3±1.5, P=0.001) and HAS-BLED score (2.4±0.9 vs.2.2±0.8, P=0.013). During 1 year follow-up, incidence of TIMI major bleeding.minor bleeding and minimal bleeding were 0.4%, 1.2%, and 10.6% in DAT group, which was lower than that in TAT group (1.0%, 1.3%, and 16.1%, respectively, P=0.040). Whereas, the occurrence rates of 1-year all-cause mortality, stroke, systemic embolism, myocardial infarction, in-stent thrombosis, in-stent restenosis and unplanned revascularization were 3.5%, 2.0%, 4.7%, 0.4%, 0.4%, and 1.6% in DAT group, which were similar in TAT group (3.3%, 2.3%, 4.3%, 0.3%, 0.0% and 2.3%, respectively, P=0.645).

In this real-world study, patients with AF concomitant with ACS or undergoing PCI treated on NOAC-based DAT showed lower bleeding rates than those with TAT, while composite end point of death or embolism events were similar between groups.

Atrial fibrillation; Acute coronary syndrome; Percutaneous coronary intervention; Non-vitamin K antagonist oral anticoagulants; Antithrombotic therapy