Antithrombotic Strategies in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

被引:0
作者
Rajagopalan B. [1 ]
Madias C. [1 ]
机构
[1] The Cardiovascular Center, Tufts Medical Center, Boston, 02111, MA
关键词
Antithrombotic therapy; Atrial fibrillation; Coronary artery disease; Percutaneous coronary interventions;
D O I
10.1007/s11936-019-0705-8
中图分类号
学科分类号
摘要
Purpose of review: The choice of appropriate antithrombotic therapy in patients with atrial fibrillation (AF) undergoing percutaneous coronary interventions (PCI) should be approached prudently. Careful consideration is necessary, balancing the ischemic and bleeding risk. Traditionally, triple antithrombotic therapy comprising of aspirin, a P2Y12 inhibitor, and an oral anticoagulant is associated with high bleeding rates. Recent findings: Recent trials have evaluated the safety and effectiveness of dual antithrombotic therapy in AF patients undergoing PCI. These studies have shown a significant reduction in bleeding with no increase in ischemic events. Clopidogrel is the preferred P2Y12 agent in the dual antithrombotic regimens. The novel oral anticoagulants (NOAC) rivaroxaban and dabigatran have been evaluated as part of dual antithrombotic therapy and are preferred options for oral anticoagulation in AF patients undergoing PCI. Studies are in progress to evaluate the role of alternate NOACs in this clinical scenario. Summary: This review explores the contemporary management of antithrombotic therapy in AF patients undergoing PCI. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
引用
收藏
相关论文
共 35 条
[1]  
Benjamin E.J., Virani S.S., Callaway C.W., Chamberlain A.M., Chang A.R., Cheng S., Chiuve S.E., Cushman M., Delling F.N., Deo R., de Ferranti S.D., Ferguson J.F., Fornage M., Gillespie C., Isasi C.R., Jimenez M.C., Jordan L.C., Judd S.E., Lackland D., Lichtman J.H., Lisabeth L., Liu S., Longenecker C.T., Lutsey P.L., Mackey J.S., Matchar D.B., Matsushita K., Mussolino M.E., Nasir K., O'Flaherty M., Palaniappan L.P., Pandey A., Pandey D.K., Reeves M.J., Ritchey M.D., Rodriguez C.J., Roth G.A., Ro
[2]  
Kralev S., Schneider K., Lang S., Suselbeck T., Borggrefe M., Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography, PLoS One, 6, 9, (2011)
[3]  
Connolly S., Pogue J., Hart R., Pfeffer M., Hohnloser S., Chrolavicius S., Et al., Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of vascular events (ACTIVE W): a randomised controlled trial, Lancet, 367, 9526, pp. 1903-1912, (2006)
[4]  
January C.T., Wann L.S., Alpert J.S., Calkins H., Cigarroa J.E., Cleveland J.C., Et al., 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: executive summary, J Am Coll Cardiol, 64, 21, pp. 2246-2280, (2014)
[5]  
2011 ACCF/AHA/SCAI Guideline for percutaneous coronary intervention, A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J am Coll Cardiol., 58, 24, pp. ee44-e122, (2011)
[6]  
Neumann F.-J., Sousa-Uva M., Ahlsson A., Alfonso F., Banning A.P., Benedetto U., Et al., 2018 ESC/EACTS Guidelines on myocardial revascularization, European Heart Journal, 40, 2, pp. 87-165, (2018)
[7]  
Levine G.N., Bates E.R., Bittl J.A., Brindis R.G., Fihn S.D., Fleisher L.A., Granger C.B., Lange R.A., Mack M.J., Mauri L., Mehran R., Mukherjee D., Newby L.K., O'Gara P.T., Sabatine M.S., Smith P.K., 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease, A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, 68, 10, pp. 1082-1115, (2016)
[8]  
Mihatov N., Secemsky E.A., Elmariah S., Triple therapy: when, if ever?, Curr Treat Options Cardiovasc Med, 20, 7, (2018)
[9]  
Faza N.N., Mentias A., Parashar A., Chaudhury P., Barakat A.F., Agarwal S., Et al., Bleeding complications of triple antithrombotic therapy after percutaneous coronary interventions, Catheter Cardiovasc Interv, 89, 2, pp. E64-E74, (2017)
[10]  
Ruiz-Nodar J.M., Marin F., Hurtado J.A., Valencia J., Pinar E., Pineda J., Gimeno J.R., Sogorb F., Valdes M., Lip G.Y.H., Anticoagulant and antiplatelet therapy use in 426 patients with atrial fibrillation undergoing percutaneous coronary intervention and stent implantation, Implications for Bleeding Risk and Prognosis, 51, 8, pp. 818-825, (2008)