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Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A North

Dominick J Angiolillo1, Shaun G Goodman2, Deepak L Bhatt2

  • 1From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.). dominick.angiolillo@jax.ufl.edu.

Circulation. Cardiovascular Interventions
|November 3, 2016
PubMed

Insights

Managing atrial fibrillation patients after stenting requires careful antithrombotic therapy. This expert consensus provides guidance on balancing stroke and bleeding risks for optimal treatment.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Optimal antithrombotic therapy for atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) with stenting is unclear.
  • Existing guidelines offer limited recommendations due to insufficient evidence-based data.
  • Expert consensus documents have historically guided clinical management in this high-risk population.

Purpose of the Study:

  • To provide an updated expert opinion on managing AF patients undergoing PCI.
  • To address critical factors: embolic/stroke risk, ischemic/thrombotic cardiac risk, and bleeding risk.
  • To offer pragmatic, consensus-derived recommendations for antithrombotic treatment.

Main Methods:

  • Review of current literature and recent advancements in antithrombotic pharmacology.
  • Consideration of evolving stent designs and relevant clinical trial outcomes.
  • Consensus-building among selected North American experts from the US and Canada.

Main Results:

  • The document outlines current expert views on assessing and managing stroke, cardiac ischemic, and bleeding risks.
  • Recent pharmacological and technological advancements relevant to AF patients undergoing PCI are discussed.
  • Expert consensus-derived recommendations are presented for a pragmatic approach to treatment.

Conclusions:

  • There is a need for updated guidance on antithrombotic therapy in AF patients undergoing PCI.
  • Balancing thrombotic and bleeding risks is crucial for tailoring treatment strategies.
  • This expert consensus provides actionable recommendations for clinicians managing these complex patients.

Keywords:
anticoagulantantiplatelet therapyatrial fibrillationhemorrhagestentthrombosis

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