Changes in Antithrombotic Therapy Over Time and Durability of a Prasugrel WOEST-Like Regimen for Percutaneous Coronary Intervention Patients With Atrial Fibrillation　― Post Hoc Analysis of the PENDULUM Mono and PENDULUM Registries ―

Koichi Nakao; Kazushige Kadota; Yoshihisa Nakagawa; Junya Shite; Hiroyoshi Yokoi; Ken Kozuma; Kengo Tanabe; Takashi Akasaka; Toshiro Shinke; Takafumi Ueno; Atsushi Hirayama; Shiro Uemura; Atsushi Harada; Takeshi Kuroda; Atsushi Takita; Raisuke Iijima; Yoshitaka Murakami; Shigeru Saito; Masato Nakamura

doi:10.1253/circrep.CR-22-0032

Cardiovascular Intervention

Changes in Antithrombotic Therapy Over Time and Durability of a Prasugrel WOEST-Like Regimen for Percutaneous Coronary Intervention Patients With Atrial Fibrillation　― Post Hoc Analysis of the PENDULUM Mono and PENDULUM Registries ―

Koichi Nakao, Kazushige Kadota, Yoshihisa Nakagawa, Junya Shite, Hiroyoshi Yokoi, Ken Kozuma, Kengo Tanabe, Takashi Akasaka, Toshiro Shinke, Takafumi Ueno, Atsushi Hirayama, Shiro Uemura, Atsushi Harada, Takeshi Kuroda, Atsushi Takita, Raisuke Iijima, Yoshitaka Murakami, Shigeru Saito, Masato Nakamura

Author information

Koichi Nakao
Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center [Japan]
Kazushige Kadota
Department of Cardiology, Kurashiki Central Hospital [Japan]
Yoshihisa Nakagawa
Department of Cardiovascular Medicine, Shiga University of Medical Science [Japan]
Junya Shite
Division of Cardiology, Osaka Saiseikai Nakatsu Hospital [Japan]
Hiroyoshi Yokoi
Cardiovascular Medicine Center, Fukuoka Sanno Hospital [Japan]
Ken Kozuma
Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital [Japan]
Kengo Tanabe
Division of Cardiology, Mitsui Memorial Hospital [Japan]
Takashi Akasaka
Department of Cardiovascular Medicine, Wakayama Medical University [Japan]
Toshiro Shinke
Division of Cardiology, Department of Medicine, Showa University School of Medicine [Japan]
Takafumi Ueno
Department of Cardiovascular Medicine, Fukuoka Kinen Hospital [Japan]
Atsushi Hirayama
Department of Cardiology, Osaka Police Hospital [Japan]
Shiro Uemura
Department of Cardiology, Kawasaki Medical School [Japan]
Atsushi Harada
Medical Information Department, Daiichi Sankyo Co., Ltd. [Japan]
Takeshi Kuroda
Primary Medical Science Department, Daiichi Sankyo Co., Ltd. [Japan]
Atsushi Takita
Data Intelligence Department, Daiichi Sankyo Co., Ltd. [Japan]
Raisuke Iijima
Division of Cardiovascular Medicine, Toho University Ohashi Medical Center [Japan]
Yoshitaka Murakami
Department of Medical Statistics, School of Medicine, Toho University [Japan]
Shigeru Saito
Division of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital [Japan]
Masato Nakamura
Division of Cardiovascular Medicine, Toho University Ohashi Medical Center [Japan]

Keywords: Atrial fibrillation, Bleeding, Japan, Percutaneous coronary intervention, Prasugrel

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Supplementary material

2022 Volume 4 Issue 5 Pages 194-204

DOI https://doi.org/10.1253/circrep.CR-22-0032

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Abstract

Background: Previously published randomized atrial fibrillation (AF) percutaneous coronary intervention (PCI) trials have demonstrated the safety and efficacy of a WOEST-like regimen (oral anticoagulant [OAC] plus P2Y₁₂inhibitor) in patients with AF PCI within 1 year. However, the efficacy of this regimen in real-world practice has not been fully confirmed, especially the efficacy of the WOEST-like regimen using the approved dose of prasugrel in Japan.

Methods and Results: This post hoc analysis included 186 and 220 patients from the PENDULUM mono and PENDULUM registries, respectively. Endpoints were the cumulative incidences of clinically relevant bleeding (CRB) and major adverse cardiac and cerebrovascular events (MACCE) at 12 months after PCI. Differences in the enrollment period led to an increase in OAC prescriptions (from 64.7% to 81.2%) and a reduction in the median duration of triple antithrombotic therapy (from 203.0 to 32.0 days) in the PENDULUM vs. PENDULUM mono registries, respectively. After adjustment by the inverse probability of treatment method, in patients with OAC, PENDULUM mono AF significantly reduced CRB without increasing MACCE compared with PENDULUM AF.

Conclusions: A WOEST-like regimen with prasugrel may reduce CRB, without increasing MACCE, in Japanese patients with AF and high bleeding risk undergoing PCI.

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