[Antithrombotic Therapy in Patients with Acute Coronary Syndrome and Atrial Fibrillation]

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Increasing prevalence of atrial fibrillation (AF) and need for oral anticoagulation (OAC).
• Concurrent need for dual antiplatelet therapy (DAPT) in AF patients with acute coronary syndrome/stent implantation.
• Traditional triple therapy (TT) carries a high bleeding risk without established efficacy or safety data.

Purpose of the Study:

• To evaluate the efficacy and safety of non-vitamin K oral anticoagulants (NOACs) plus a single antiplatelet agent versus traditional triple therapy in AF patients.
• To compare bleeding complications and ischemic events between dual therapy and triple therapy regimens.
• To inform guideline recommendations for managing AF patients requiring anticoagulation and antiplatelet therapy.

Main Methods:

• Analysis of four major prospective randomized trials (PIONEER AF-PCI, RE-DUAL PCI, AUGUSTUS, ENTRUST-AF-PCI).
• Comparison of NOACs plus one antiplatelet agent against vitamin K antagonists plus DAPT.
• Assessment of stroke rates, cardiac ischemic events, and bleeding complications.

Main Results:

• Dual therapy (NOAC + single antiplatelet) demonstrated significantly lower bleeding complications compared to triple therapy.
• No statistically significant increase in stroke rates or major cardiac ischemic events observed with dual therapy.
• Four major NOACs (rivaroxaban, dabigatran, apixaban, edoxaban) were evaluated in these trials.

Conclusions:

• Dual therapy with a NOAC and a single antiplatelet agent is superior to triple therapy regarding bleeding risk in AF patients.
• This dual therapy approach offers comparable protection against stroke and cardiac ischemic events.
• International guidelines increasingly recommend dual therapy over triple therapy for selected AF patients, especially those with high bleeding risk.