Antithrombotic Regimens in Patients With Atrial Fibrillation and Coronary Disease Optimizing Efficacy and Safety ∗

Clear evidence supports the value of oral anticoagulation (OAC) with vitamin K antagonists in preventing stroke and thromboembolism in patients with atrial fibrillation (AF) who have well-established risk factors. For this indication, vitamin K antagonists have been shown to be superior to single or dual antiplatelet agents in reducing thromboembolic complications (1). Yet, up to 30% of patients with AF also have indications for antiplatelet therapy because of coronary artery disease (2). Dual antiplatelet therapy with aspirin and a P2Y12 receptor inhibitor (e.g., clopidogrel) is usually recommended after stent implantation or acute coronary syndrome (3). Thus, patients with both AF and coronary events typically receive combination OAC and antiplatelet therapy. There has been concern that withholding antiplatelet therapy in these patients could expose them to higher rates of stent thrombosis and myocardial infarction (MI), and P2Y12 inhibitors seem to be particularly important in this regard. Yet, the combination of OAC with antiplatelet drugs clearly increases the risk of major hemorrhages and fatal bleeding in both AF and coronary populations (4,5,6). European guidelines from 2010 suggest triple therapy after stent implantation, with the duration depending on the type of stent implanted, the presence of an acute coronary syndrome, and the bleeding risk of the patient. (7) An earlier guideline document from the American College of Cardiology, American Heart Association, and ...
Source: Journal of the American College of Cardiology: Cardiovascular Imaging - Category: Radiology Source Type: research