Should patients with atrial fibrillation and stable coronary artery disease receive an oral anticoagulant, an antiplatelet or both?

Patients with atrial fibrillation necessitating anticoagulation frequently develop concomitant stable coronary artery disease requiring antiplatelet therapy and vice versa. The optimal choice of antithrombotic therapy in this cohort has been unclear. Which therapy is most effective at reducing mortality and thrombotic events while avoiding a disproportionate increase in bleeding risk? EBM verdict EBM Verdict on: Antithrombotic therapy for atrial fibrillation with stable coronary disease. N Engl J Med 2019;381:1103-–1113. doi: 10.1056/NEJMoa1904143. In patients with atrial fibrillation and stable coronary artery disease, monotherapy with rivaroxaban is non-inferior to combination therapy with rivaroxaban and an antiplatelet in terms of preventing death and cardiovascular events. Rivaroxaban monotherapy is associated with less major bleeding. In patients with atrial fibrillation (AF) who have recently undergone percutaneous coronary intervention (PCI) and have a high ischaemic risk, current guidelines recommend triple therapy (with aspirin, a P2Y12 inhibitor and an oral anticoagulant (OAC)) for...
Source: Evidence-Based Medicine - Category: Internal Medicine Authors: Tags: General Medicine, EBM Verdict Source Type: research