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J Am Coll Cardiol. 2019 Jun 27. pii: S0735-1097(19)35400-2. doi: 10.1016/j.jacc.2019.02.080. [Epub ahead of print]

Antithrombotic Agents: From Aspirin to DOACs in Coronary Artery Disease and in Atrial Fibrillation (Part I).

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Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands. Electronic address:
Department of Cardiology, Sint-Antonius Ziekenhuis, Nieuwegein, The Netherlands.
Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom.
Department of Cardiology, Timone University Hospital Center, Marseille, France.
Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina.


For secondary prevention of coronary artery disease (CAD), oral antiplatelet therapy is essential. In case of coronary intervention, temporary dual antiplatelet therapy is mandatory as well. Recently, low-dose oral anticoagulation has entered the CAD arena. Atrial fibrillation (AF) is often seen in CAD and vice versa. In most patients stroke prevention in AF consists of oral anticoagulation. In many cases of CAD in patients with AF, anticoagulation has to be combined with antiplatelet agents (so called, dual pathway antithrombotic therapy). Excess bleeding in these conditions is a rapidly rising problem. This review addresses the antithrombotic options in CAD alone, in AF alone, and in their combination, when either an invasive or a noninvasive approach has been chosen.


antiplatelet therapy; atrial fibrillation; coronary artery disease; oral anticoagulant agents; percutaneous coronary intervention


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