Open AccessAtrial fibrillation patients undergoing percutaneous coronary intervention: dual or triple antithrombotic therapy with non-vitamin K antagonist oral anticoagulants
Author(s) -
Andreas Goette,
Pascal Vranckx
Publication year - 2020
Publication title -
european heart journal supplements
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.389
H-Index - 36
eISSN - 1554-2815
pISSN - 1520-765X
DOI - 10.1093/eurheart/suaa101
Subject(s) - medicine , rivaroxaban , edoxaban , percutaneous coronary intervention , vitamin k antagonist , dabigatran , apixaban , conventional pci , atrial fibrillation , aspirin , cardiology , antithrombotic , warfarin , coronary artery disease , anesthesia , myocardial infarction
About 20% of all atrial fibrillation (AF) patients develop coronary artery disease, which requires coronary stenting [percutaneous coronary intervention (PCI)]. Thus, this subcohort of AF patients may require aggressive antithrombotic therapy encompassing vitamin K antagonist (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC) plus aspirin and a P2Y12 inhibitor. At present, four clinical Phase IIIb trials using dabigatran, rivaroxaban, apixaban, or edoxaban, were published. These studies assessed the impact of NOACs as a part of DAT therapy vs. triple therapy. Compared with triple therapy, NOAC-based DAT has been shown to be associated with reduced major bleeding as well as intracranial haemorrhages. The benefit, however, is somewhat counterbalanced by a higher risk of stent-related ischaemia during the early phase of dual therapy. Thus, triple therapy after stenting is appropriate for at least 14 days with a maximum of 30 days. Thereafter, DAT including a NOAC is the therapy of choice in AF PCI patients to reduce the risk of bleeding during a 1 year of follow-up compared to VKA-based regimes. The present review summarizes the published study results and demonstrates differences in trial design and reported outcomes.