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Antiplatelet and Antithrombotic Therapy in Patients with Atrial Fibrillation Undergoing Coronary Stenting

Mikhail S Dzeshka1, Richard A Brown2, Davide Capodanno3

  • 1University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK; Department of Internal Medicine I, Grodno State Medical University, Gorkogo 80, Grodno 230009, Belarus.

Interventional Cardiology Clinics
|November 26, 2016
PubMed

Insights

For atrial fibrillation patients needing anticoagulation and antiplatelet therapy, triple therapy is recommended for a limited duration. This approach balances stroke prevention with reduced bleeding risks.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Atrial fibrillation management prioritizes stroke prevention.
  • Many patients require oral anticoagulation (OAC) and may undergo percutaneous coronary intervention.
  • Dual antiplatelet therapy (DAPT) is crucial for preventing ischemia and stent thrombosis post-intervention.

Purpose of the Study:

  • To outline optimal antithrombotic strategies for atrial fibrillation patients.
  • To balance the risks of thromboembolism and bleeding in this population.
  • To provide guidance on managing dual and triple antithrombotic therapies.

Main Methods:

  • Review of current guidelines and evidence for antithrombotic therapy in atrial fibrillation.
  • Analysis of treatment durations for triple therapy (OAC + DAPT), dual therapy (OAC + antiplatelet), and OAC monotherapy.
  • Consideration of adjunctive measures to mitigate bleeding risk.

Main Results:

  • Triple antithrombotic therapy (OAC + DAPT) should be used for the shortest feasible duration.
  • Following triple therapy, a dual antithrombotic regimen (OAC + antiplatelet) is recommended for up to 12 months.
  • Long-term management involves OAC monotherapy after 12 months.

Conclusions:

  • A sequential antithrombotic strategy is essential for atrial fibrillation patients.
  • Minimizing triple therapy duration is key to reducing hemorrhagic complications.
  • Recommendations include new-generation drug-eluting stents, lower-intensity OAC, radial access, and proton pump inhibitors for gastric protection.

Keywords:
Acute coronary syndromeAntiplatelet therapyAtrial fibrillationCoronary artery diseaseOral anticoagulationPercutaneous coronary interventionStentingStroke

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