Triple antithrombotic therapy in patients with atrial fibrillation undergoing PCI: Current evidence and practice.

Triple antithrombotic therapy in patients with atrial fibrillation undergoing PCI: Current evidence and practice. Expert Rev Cardiovasc Ther. 2018 Sep 14;: Authors: Clarke A, Ibrahim A, Kiernan TJ Abstract INTRODUCTION: Patients with atrial fibrillation taking oral anticoagulation and undergoing percutaneous coronary intervention with stent insertion are recommended to receive antithrombotic therapy with aspirin and P2Y12 receptor antagonist. This combinatory regime encompasses triple therapy (TT). Although TT reduces the risk of ischaemic events such as stroke and stent thrombosis, it is associated with an increased bleeding risk. Areas covered: The efficacy and safety profile of TT is uncertain with undetermined optimal duration and therapeutic combination. This review summarises relevant trials evaluating TTs application and introduces exploration of duration and dosage in addition to other contributory factors including stent type and choice of antithrombotic agents. Expert commentary: TT has shown to be effective for reduction of ischaemic risk. However, trials have failed to demonstrate the regime's superiority in efficacy over alternatives such as dual therapy (single antiplatelet plus anticoagulant) and continue to denote an increased bleeding risk. Further research driven by a balance between thromboembolic and bleeding end points is required to demonstrate TTs potential beneficence, along with optimal duration identification and antithrombotic c...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Related Links:

Authors: Gumprecht J, Domek M, Lip GY Abstract Introduction: The non-vitamin K antagonist oral anticoagulants (NOACs) are changing the landscape for stroke prevention in atrial fibrillation (AF) and prevention or treatment of venous thromboembolism (VTE). In patients with AF and concomitant acute coronary syndrome (ACS), the treatment regimen of combined NOACs and P2Y12 inhibitors is gaining popularity. Areas covered: The authors conducted a review of studies published in the last 10 years regarding safety evaluation and effectiveness of apixaban for the treatment of AF and ACS, both alone and in combination with d...
Source: Expert Opinion on Drug Safety - Category: Drugs & Pharmacology Tags: Expert Opin Drug Saf Source Type: research
gro G Abstract Background: Combination of dual antiplatelet (DAPT) and oral anticoagulation therapy is required to decrease cardioembolic stroke and stent thrombosis risk in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS). We compared the safety and efficacy of dabigatran etexilate with vitamin K antagonist (VKA), in combination with DAPT (aspirin plus clopidogrel) treatment in AF patients who underwent percutaneous coronary intervention (PCI) with stenting for ACS. Methods: Consecutive nonvalvular AF patients who received twice-daily dabigatran 110 mg (n = 389) or VKA (n = 510) and D...
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
Publication date: November 2018Source: Canadian Journal of Cardiology, Volume 34, Issue 11Author(s): Jason G. Andrade, Marc W. Deyell, Graham C. Wong, Laurent MacleAbstractAtrial fibrillation (AF) is a progressive chronic disease characterized by exacerbations and periods of remission. It is estimated that up to 20% to 30% of those with AF also have coronary artery disease (CAD), and 5% to 15% will require percutaneous coronary intervention (PCI). In patients with concomitant AF and CAD, management remains challenging and requires a careful and balanced assessment of the risk of bleeding against the anticipated impact on i...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
Publication date: Available online 20 August 2018Source: Canadian Journal of CardiologyAuthor(s): Jason G. Andrade, Marc W. Deyell, Graham C. Wong, Laurent MacleABSTRACTAtrial fibrillation (AF) is a progressive chronic disease characterized by exacerbations and periods of remission. It is estimated that up to 20-30% of those with AF also have coronary artery disease (CAD), and 5-15% will require percutaneous coronary intervention (PCI). In patients with concomitant AF and CAD, management remains challenging and requires a careful and balanced assessment of the risk of bleeding against the anticipated impact on ischemic out...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
ConclusionsIn this long-term study of high-risk and real-world AF-patients with PCI, DT with NOAC and P2Y12 inhibitor (6  months) followed by NOAC monotherapy was safe and effective.
Source: Cardiology and Therapy - Category: Cardiology Source Type: research
AbstractThe number of patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) is increasing. Since these patients have a CHA2DS2-VASc score of 1 or higher, they should be treated with oral anticoagulation to prevent stroke. However, combination therapy with oral anticoagulation for prevention of embolic stroke and dual platelet inhibition for prevention of coronary thrombosis significantly increases bleeding complications. The optimal combination, intensity and duration of antithrombotic combination therapy is still not known. In the rather small randomized WOEST trial, the combination of a vi...
Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
ConclusionsIn this long-term study of high-risk and real-world AF-patients with PCI, DT with NOAC and P2Y12 inhibitor (6  months) followed by NOAC monotherapy was safe and effective.
Source: Cardiology and Therapy - Category: Cardiology Source Type: research
Publication date: June 2018 Source:American Heart Journal, Volume 200 Author(s): Renato D. Lopes, Amit N. Vora, Danny Liaw, Christopher B. Granger, Harald Darius, Shaun G. Goodman, Roxana Mehran, Stephan Windecker, John H. Alexander Background The optimal antithrombotic strategy for patients with atrial fibrillation (AF) who develop acute coronary syndrome (ACS) and/or the need for percutaneous coronary intervention (PCI) is uncertain. The risk of bleeding is a major concern when oral anticoagulation is required to prevent stroke, and concomitant therapy with antiplatelet agents is required to minimize recurrent ischemic ...
Source: American Heart Journal - Category: Cardiology Source Type: research
Publication date: Available online 9 March 2018 Source:American Heart Journal Author(s): Renato D. Lopes, Amit N. Vora, Danny Liaw, Christopher B. Granger, Harald Darius, Shaun G. Goodman, Roxana Mehran, Stephan Windecker, John H. Alexander The optimal antithrombotic strategy for patients with atrial fibrillation (AF) who develop acute coronary syndrome (ACS) and/or the need for percutaneous coronary intervention (PCI) is uncertain. The risk of bleeding is a major concern when oral anticoagulation is required to prevent stroke and concomitant therapy with antiplatelet agents is required to minimize recurrent ischemic even...
Source: American Heart Journal - Category: Cardiology Source Type: research
BackgroundMore evidence is needed on the optimal antithrombotic regimen in elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). HypothesisOctogenarian patients (aged ≥80 years) with AF who underwent PCI have worse 12‐month clinical outcome, compared with younger patients. MethodsWe performed a post‐hoc analysis of data from the prospective, multicenter AFCAS registry, which enrolled consecutive patients with AF who underwent PCI and stenting. Outcome measures included major adverse cardiac/cerebrovascular events (MACCE; all‐cause death, myocardial infarction, repeat r...
Source: Clinical Cardiology - Category: Cardiology Authors: Tags: CLINICAL INVESTIGATIONS Source Type: research
More News: Angioplasty | Aspirin | Atrial Fibrillation | Bleeding | Cardiology | Cardiovascular | Coronary Angioplasty | Heart | Ischemic Stroke | Percutaneous Coronary Intervention | Stroke | Thrombosis