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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: Where Are
Ryan G D'Angelo1,2, Thaddeus McGiness1,2, Laura H Waite1,2
11 University of the Sciences-Philadelphia College of Pharmacy, Philadelphia, PA, USA.
Insights
For patients with atrial fibrillation (AF) needing percutaneous coronary intervention (PCI), triple therapy (TT) is recommended for the shortest duration. Dual therapy (DT) may suit those with low thrombosis risk or high bleeding risk.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) often require antithrombotic therapy.
- Balancing the risk of cardiovascular events and bleeding is crucial in these high-risk patients.
- Current guidelines offer varying recommendations on dual therapy (DT) versus triple therapy (TT).
Purpose of the Study:
- To synthesize existing literature on the efficacy and safety of DT and TT in AF patients undergoing PCI.
- To provide evidence-based guidance for clinicians managing antithrombotic therapy in this population.
Main Methods:
- A comprehensive literature search of PubMed and MEDLINE databases from January 2000 to February 2018.
- Inclusion of randomized trials, nonrandomized trials, and meta-analyses focusing on AF, PCI, and antithrombotic strategies.
- Data extraction based on study design, patient population, interventions, comparators, and key cardiovascular and bleeding outcomes.
Main Results:
- Fifteen studies were included, primarily evaluating clopidogrel and warfarin-based DT and TT regimens.
- Evidence supporting DT's non-inferiority to TT in preventing cardiovascular events often comes from observational studies in low-risk populations.
- Current evidence and guidelines support TT for the shortest possible duration in most AF patients undergoing PCI.
Conclusions:
- Triple therapy (TT) is recommended for the shortest duration feasible in most patients with atrial fibrillation (AF) requiring percutaneous coronary intervention (PCI).
- Dual therapy (DT) may be a suitable alternative for patients with a low risk of thrombosis and/or a high risk of bleeding.
Objective:
To synthesize the literature and provide guidance to practitioners regarding double therapy (DT) and triple therapy (TT) in patients with atrial fibrillation (AF) requiring percutaneous coronary intervention (PCI).
Data Sources:
PubMed and MEDLINE (January 2000 to February 2018) were searched using the following terms: atrial fibrillation, myocardial infarction, acute coronary syndrome, percutaneous coronary intervention, anticoagulation, dual-antiplatelet therapy, clopidogrel, aspirin, ticagrelor, prasugrel, and triple therapy.
Study Selection And Data Extraction:
The results included randomized and nonrandomized clinical trials and meta-analyses. Each study was reported based on study design, population, intervention, comparator, and key cardiovascular (CV) and bleeding outcomes.
Data Synthesis:
A total of 15 studies were included in the review. The majority of studies evaluating DT and TT utilized clopidogrel and warfarin as components of the regimen, although there are emerging data with newer agents. Evidence purporting DT regimens to be equally effective in preventing CV events and improved safety profiles compared with TT regimens included populations with relatively low risk for recurrent CV events, and many of these studies were observational in nature. Overall, current evidence as well as American and European guidelines support the use of TT in patients with AF who require PCI for the least possible amount of time, depending on patient-specific factors involving bleeding and thrombosis.
Conclusions:
In the majority of patients with AF who require PCI, TT should be used for the shortest period of time possible. DT regimens may be used in patients requiring PCI who have low risk for thrombosis and/or high bleeding risk.
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