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

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Procedural and Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous

Domenico Simone Castiello1, Federica Buongiorno1, Lina Manzi1

  • 1Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy.

Journal of Cardiovascular Development and Disease
|April 25, 2025
PubMed

Insights

Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) face high bleeding risks. This review explores strategies to balance antithrombotic therapy for optimal outcomes in this complex patient group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Percutaneous coronary intervention (PCI) is a primary treatment for coronary artery disease (CAD).
  • Dual antiplatelet therapy (DAPT) is crucial post-PCI, but many patients also require oral anticoagulants (OACs) for atrial fibrillation (AF).
  • Combining OACs with DAPT significantly elevates bleeding risk.

Purpose of the Study:

  • To review current procedural and antithrombotic strategies for patients with AF undergoing PCI.
  • To optimize the balance between preventing ischemic events and minimizing bleeding complications in this population.

Main Methods:

  • Review of existing literature on antithrombotic strategies in patients with AF undergoing PCI.
  • Comparison of dual antithrombotic therapy (DAT) versus triple antithrombotic therapy (TAT) regarding bleeding and thrombotic risks.
  • Discussion of procedural considerations to mitigate risks.

Main Results:

  • Dual antithrombotic therapy (DAT) reduces bleeding compared to triple antithrombotic therapy (TAT).
  • However, DAT may be associated with an increased risk of stent thrombosis.
  • Patients with AF undergoing PCI present unique challenges requiring tailored management.

Conclusions:

  • Managing antithrombotic therapy in AF patients undergoing PCI requires careful consideration of individual risk factors.
  • Strategies to reduce bleeding complications are essential.
  • Further research and optimized protocols are needed to improve both ischemic and bleeding outcomes.

Keywords:
antiplateletatrial fibrillationbleedingintracoronary imagingoral anticoagulantpercutaneous coronary interventionthrombosisvascular access

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