Advances in Antiplatelet and Anticoagulant Therapies for NSTE-ACS

AbstractThe treatment of patients requiring anticoagulation who develop acute coronary syndrome (ACS) and/or require percutaneous coronary intervention (PCI) must balance the reduction in major adverse cardiovascular events, stroke, and major bleeding. The development of direct oral anticoagulants (DOACs) for the treatment of atrial fibrillation has ushered in an era of potential treatment options for these complex patients.Purpose of ReviewTo review the clinical evidence underlying the use of DOACs for the treatment of patients with atrial fibrillation and ACS or PCI.Recent FindingsThree trials studied this particular patient population; WOEST showed that dual therapy with warfarin and clopidogrel decreased hemorrhage at 1  year compared with standard triple therapy (19.4 vs. 44.4% HR 0.36; 95% CI 0.26–0.50;P <  0.0001), without increasing thromboembolic events (11.1 vs. 17.6% HR 0.60; 95% CI 0.38–0.94;P = 0.025). PIONEER AF-PCI showed that 10–15 mg rivaroxaban plus P2Y12 inhibitor for 12  months significantly lowered bleeding rates than standard triple therapy (16.8 vs. 26.7% HR 0.59; 95% CI 0.47–0.76;P <  0.001) and had equivalent rates of MACE. Finally, REDUAL-PCI compared two different doses of dabigatran (110 mg twice daily and 150 mg twice daily) plus P2Y12 inhibitor with standard triple therapy and reported reduced ISTH bleeding with both doses; HR 0.52 with 110  mg dabigatran (95% CI 0.42–0.63,P <  0.001) and HR 0.72 with 150 mg ...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research