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J Am Coll Cardiol. 2019 Jul 9;74(1):83-99. doi: 10.1016/j.jacc.2019.05.016.

Management of Antithrombotic Therapy in Atrial Fibrillation Patients Undergoing PCI: JACC State-of-the-Art Review.

Author information

1
Division of Cardiology, A.O.U. "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy. Electronic address: https://twitter.com/DFCapodanno.
2
3rd Medical Department, Cardiology and Intensive Care Medicine and Sigmund Freud University, Medical Faculty, Vienna, Austria.
3
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
4
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
5
Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts.
6
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
7
Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, and faculty of Medicine and Life Sciences at the University of Hasselt, Hasselt, Belgium.
8
Cardiology Department, Nîmes University Hospital, ACTION Study Group, Montpellier University, Nîmes, France.
9
Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
10
Mayo Clinic College of Medicine, Rochester, Minnesota.
11
Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida. Electronic address: dominick.angiolillo@jax.ufl.edu.

Abstract

Most patients with atrial fibrillation (AF) and risk factors for stroke require oral anticoagulation (OAC) to decrease the risk of stroke or systemic embolism. This is now best achieved with direct oral anticoagulants that decrease the risk of intracranial bleeding compared with vitamin K antagonists. Of note, approximately 5% to 10% of patients undergoing percutaneous coronary intervention have AF, which complicates antithrombotic therapy in daily practice, because the guidelines recommend that these patients also receive dual antiplatelet therapy (DAPT) to reduce the risk of ischemic complications. However, combining OAC with DAPT, a strategy also known as triple antithrombotic therapy, is known to increase the risk of bleeding compared with the use of OAC or DAPT alone. Studies of direct oral anticoagulants are now emerging that show the favorable safety profile of double antithrombotic therapy with OAC and a P2Y12 inhibitor in comparison with triple antithrombotic therapy including the use of vitamin K antagonists. The scope of this review is to provide an update on this topic as well as to discuss future directions in the management of antithrombotic therapy after percutaneous coronary intervention in AF patients requiring chronic OAC.

KEYWORDS:

atrial fibrillation; coronary stenting; oral anticoagulant; oral antiplatelet

PMID:
31272556
DOI:
10.1016/j.jacc.2019.05.016

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