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Antithrombotic treatment in atrial fibrillation patients undergoing percutaneous coronary interventions: focus on

Marco Vitolo1,2, Saad Javed1,3, Davide Capodanno4

  • 1Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital , Liverpool, UK.

Expert Review of Cardiovascular Therapy
|August 11, 2020
PubMed

Insights

Dual therapy (DAT) offers a better safety profile than triple antithrombotic therapy (TAT) for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). However, concerns remain regarding stent thrombosis (ST) risk with DAT.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Coronary artery disease (CAD) frequently coexists with atrial fibrillation (AF), necessitating oral anticoagulation (OAC).
  • Patients with AF undergoing percutaneous coronary intervention (PCI) often require antiplatelet therapy to prevent stent thrombosis (ST).
  • Dual antithrombotic therapy (DAT) shows improved safety over triple antithrombotic therapy (TAT), but ischemic outcomes require further evaluation.

Purpose of the Study:

  • To critically evaluate the efficacy and safety of DAT versus TAT in AF patients undergoing PCI.
  • To focus on the implications of these strategies for stent thrombosis (ST).

Main Methods:

  • This study is a narrative review.
  • It summarizes and critically evaluates existing clinical data.
  • Focuses on dual therapy (oral anticoagulation plus a single P2Y12 inhibitor) versus triple therapy (oral anticoagulation plus dual antiplatelet therapy).

Main Results:

  • Recent studies indicate that DAT has a more favorable safety profile compared to TAT.
  • Concerns persist regarding the potential for ischemic complications, specifically ST, with DAT due to insufficient trial power.

Conclusions:

  • Selecting an antithrombotic strategy for AF patients undergoing PCI is complex.
  • Individualized treatment considering bleeding, thrombotic, and ischemic risks is crucial.
  • A move away from 'one size fits all' approaches towards tailored antithrombotic therapy is recommended.
Abstract

Keywords:
DAPTPCIanticoagulationatrial fibrillationstent thrombosis

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