PCI is rare in Afib but post-PCI bleeding/thrombosis rates are high

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Takeaway 

  • Primary cutaneous intervention (PCI) occurs in <1% of patients patients with atrial fibrillation (Afib) at moderate-high stroke risk, but bleeding/thrombosis are high post-PCI and dual-antiplatelet treatment (DAPT) is variable.

Study design

  • Rocket-Afib trial population, randomly assigned to rivaroxaban (Xarelto) or dose-adjusted warfarin (Coumadin), comparing those who underwent PCI (153; 61 rivaroxaban, 92 warfarin) vs not (14,018).
  • 806-d follow-up.
  • Funding: Johnson & Johnson Pharmaceutical Research & Development, Bayer HealthCare AG.

Key results 

  • Patients on rivaroxaban less likely to have PCI vs warfarin group (P=.01).
  • 81% overall continued study drug treatment post-PCI.
  • Some switching from DAPT (clopidogrel+aspirin) to monotherapy (clopidogrel or aspirin) after PCI.
  • Stroke/embolism rate post-PCI was 4.5/100 patient-years; major bleeding was 10.2/100 patient-years.

Limitations

  • Usual limitations o...