Antithrombotic treatments for patients with atrial fibrillation and a requirement for a coronary artery stent

Background: Patients with atrial fibrillation and a coronary artery stent require anticoagulation to provide prophylaxis against stroke and dual antiplatelet therapy to provide prophylaxis against stent thrombosis (triple therapy). This combination increases the risk of major bleeding complications compared to either treatment alone. It is suggested that an alternative to triple therapy is high dose dual antiplatelet therapy (aspirin 325mg/day and clopidogrel 75 mg/day), which would have similar efficacy to triple therapy in relation to prophylaxis against both stroke and stent thrombosis with a lower risk of bleeding complications. Summary: 1. Patients with atrial fibrillation and a coronary artery stent require triple therapy, which is associated with increased bleeding risk. 2. In everyday practice 50% of patients do not receive this, because of the excess bleeding risk. 3. It is suggested that for patients at increased bleeding risk and for whom it is felt that triple therapy is not suitable, Aspirin (325mg daily) and clopidogrel (75mg daily) should be considered.