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Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary Syndrome

Wilbert Bor1, Diana A Gorog2,3

  • 1St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands.

Journal of Clinical Medicine
|July 2, 2020
PubMed

Insights

Managing patients with both acute coronary syndrome and atrial fibrillation requires balancing antithrombotic efficacy and bleeding risk. This review guides optimal treatment strategies for these complex cases.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Acute coronary syndrome (ACS) and atrial fibrillation (AF) frequently coexist in patients.
  • Combination therapy (dual antiplatelet therapy and oral anticoagulation) increases bleeding risk.

Purpose of the Study:

  • To review evidence for optimal antithrombotic treatment in patients with ACS and AF.
  • To guide clinicians in balancing antithrombotic efficacy and bleeding risk.

Main Methods:

  • Review of available clinical evidence.
  • Analysis of treatment choices including anticoagulation, P2Y12 inhibitors, and genetic testing.

Main Results:

  • Optimal antithrombotic strategy requires careful consideration of individual patient factors.
  • Treatment decisions involve intraprocedural anticoagulation, oral anticoagulant choice/dosing, and therapy duration.

Conclusions:

  • Balancing antithrombotic benefits against bleeding risks is crucial for patients with coexisting ACS and AF.
  • Personalized treatment selection, potentially including genetic testing, can optimize outcomes.

Keywords:
NOACacute coronary syndromeantiplatelet therapyantithrombotic therapyatrial fibrillationdual therapyoral anticoagulantspercutaneous coronary interventiontriple therapyvitamin K antagonist

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