A Tailored Antithrombotic Approach for Patients with Atrial Fibrillation Presenting with Acute Coronary Syndrome And/or Undergoing PCI: A Case Series

Overview

Journal J Clin Med

Specialty General Medicine

Date 2022 Jul 27

PMID 35887851

Authors

Simona Giubilato

Fabiana Luca

Andrea Pozzi

Giorgio Caretta

Stefano Cornara

Anna Pilleri

Concetta Di Nora

Francesco Amico

Irene Di Matteo

Silvia Favilli

Roberta Rossini

Carmine Riccio

Furio Colivicchi

Michele Massimo Gulizia

Affiliations

Soon will be listed here.

Abstract

The combination of oral anticoagulants (OAC) and dual antiplatelet therapy (DAPT) is the mainstay for the treatment of patients with atrial fibrillation (AF) presenting with acute coronary syndrome (ACS) and/or undergoing PCI. However, this treatment leads to a significant increase in risk of bleeding. In most cases, according to the most recent guidelines, triple antithrombotic therapy (TAT) consisting of OAC and DAPT, typically aspirin and clopidogrel, should be limited to one week after ACS and/or PCI (default strategy). On the other hand, in patients with a high ischemic risk (i.e., stent thrombosis) and without increased risk of bleeding, TAT should be continued for up to one month. Direct oral anticoagulants (DOAC) in triple or dual antithrombotic therapy (OAC and P2Y12 inhibitor) should be favored over vitamin K antagonists (VKA) because of their favorable risk/benefit profile. The choice of the duration of TAT (one week or one month) depends on a case-by-case evaluation of a whole series of hemorrhagic or ischemic risk factors for each patient. Likewise, the specific DOAC treatment should be selected according to the clinical characteristics of each patient. We propose a series of paradigmatic clinical cases to illustrate the decision-making work-up in clinical practice.

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