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Updated: Feb 9, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

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DAPT plus anticoagulant therapy: The difficult coexistence post-ACS in older patients with atrial fibrillation

Mauro Di Bari1, Alessandra Pratesi, Francesca M Nigro

  • 1University of Florence, Department of Experimental and Clinical Medicine. mauro.dibari@unifi.it.

Monaldi Archives for Chest Disease = Archivio Monaldi Per Le Malattie Del Torace
|June 8, 2018
PubMed

Insights

For older patients with atrial fibrillation (AF) and coronary artery disease needing stenting, triple therapy increases bleeding risk. Alternative treatments show promise for improved safety in this complex patient group.

Area of Science:

  • Cardiology
  • Pharmacology
  • Geriatrics

Background:

  • Atrial fibrillation (AF) and coronary artery disease (CAD) frequently coexist in elderly patients.
  • Percutaneous coronary intervention (PCI) with stenting is a common treatment for CAD.
  • Concurrent anticoagulation and dual antiplatelet therapy (triple therapy) is often required, posing significant bleeding risks.

Purpose of the Study:

  • To review evidence comparing triple therapy with alternative regimens in AF patients undergoing PCI.
  • To assess the safety and efficacy of different therapeutic strategies.

Main Methods:

  • Systematic review of randomized clinical trials and observational studies.
  • Comparison of triple therapy against various alternative treatment options.
  • Focus on bleeding risk and therapeutic outcomes.

Main Results:

  • Current guidelines recommend triple therapy, particularly in acute coronary syndrome (ACS).
  • Triple therapy is associated with an excessive risk of bleeding.
  • Alternative regimens to triple therapy demonstrate promising safety profiles.

Conclusions:

  • While evidence is not exhaustive, alternative strategies to triple therapy in AF patients undergoing PCI are encouraging.
  • Further research is crucial to establish optimal, safer treatment protocols.
  • Balancing antithrombotic efficacy and bleeding risk remains a key challenge.

Keywords:
Dual anti-platelet therapyacute coronary syndromeatrial fibrillationolder patients, hemorrhagic vs thromboembolic risk.triple therapy

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