• NEWS . 16 Sep 2019
  • Patients with acute coronary syndrome and atrial fibrillation

  • A study has found nearly one in 10 patients who were hospitalized for acute coronary syndrome (ACS) and underwent percutaneous coronary intervention (PCI) also had atrial fibrillation (AF). Furthermore, patients with paroxysmal AF and an increased risk of bleeding were less likely to receive anticoagulant treatment.

    In a study of 3,612 patients with ACS in China, 286 (7.9%) were diagnosed with AF, including 45 (1.2%) with paroxysmal AF, 227 (6.3%) with persistent/permanent AF and 14 (0.4%) with unclassified AF.

    Researchers noted that, although 95.5% of patients with AF were at high risk of stroke, only 21.7% were discharged on oral anticoagulants (OACs) such as warfarin (10.5%) and non-vitamin K antagonists (11.2%). Patients with pre-admission use of OACs and with a HAS-BLED score <3, with persistent/permanent AF were more likely to receive OAC treatment at discharge. HAS-BLED is a scoring system using seven parameters (hypertension, abnormal renal and liver function, stroke, bleeding, labile international normalized ratio, older age, and use of drugs or alcohol) to assess 1-year risk of major bleeding in patients with AF taking anticoagulants.

    Therefore, anticoagulant therapy was greatly underused. Patients with paroxysmal AF and an increased risk of bleeding were less likely to receive anticoagulant treatment. Further efforts should be made to increase the adherence to guideline recommendations for OACs.

    Reference:
    Mai L, et al. A retrospective cohort study of oral anticoagulant treatment in patients with acute coronary syndrome and atrial fibrillation. BMJ Open 2019;9:e031180.