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Triple oral antithrombotic therapy in atrial fibrillation and coronary artery stenting

Grant W Reed1, Christopher P Cannon

  • 1Brigham and Women's Hospital, Boston, Massachusetts.

Clinical Cardiology
|July 23, 2013
PubMed

Insights

Patients with atrial fibrillation and acute coronary syndrome need careful management of triple oral antithrombotic therapy to balance stroke prevention and bleeding risk after stenting.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) require oral anticoagulation and dual antiplatelet therapy (DAPT) post-coronary stenting.
  • Concurrent use of these agents, known as triple oral antithrombotic therapy (TAT), substantially elevates bleeding risk.

Purpose of the Study:

  • To review current evidence on the risks and benefits of TAT in AF patients undergoing coronary stenting.
  • To identify gaps in knowledge regarding optimal TAT strategies and duration.

Main Methods:

  • Literature review of recent evidence on TAT in AF patients post-ACS and stenting.
  • Discussion of clinical risk scores for predicting stroke, bleeding, and stent thrombosis.
  • Identification of areas requiring further research.

Main Results:

  • TAT significantly increases bleeding risk in AF patients post-ACS and stenting.
  • Current clinical practice relies heavily on expert opinion due to limited evidence.
  • Risk stratification tools can aid in predicting adverse events.

Conclusions:

  • Optimal TAT combination and duration remain undefined for AF patients with ACS post-stenting.
  • Further research is crucial to establish evidence-based guidelines for balancing antithrombotic therapy efficacy and safety.
  • Personalized risk assessment is key in managing these complex patients.

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