Antithrombotic Treatment in Acute Coronary Syndrome and Atrial Fibrillation

Víctor Mauro

Abstract


The incidence of patients with chronic atrial fibrillation (AF) who also present with non-ST-segment elevation acute coronary syndrome varies between 10% and 30% according to registries (1, 2). The indication of anticoagulant drugs to reduce systemic embolism poses the need to use dual antiplatelet therapy to prevent recurrent ischemic complications in patients initially treated with a conservative or invasive strategy with percutaneous coronary intervention (PCI). The challenge of individualizing the patient with the most beneficial balance between ischemic and bleeding risk is usually very controversial in this population in daily clinical practice, since there is no evidence with adequate consistency that allows consensus on standardized behaviors. Below we will briefly review the studies performed, placing emphasis on their limitations.

References


Lip GY, Laroche C, Dan GA, Santini M, Kalarus Z, Rasmussen LH, et al. A prospective survey European Society of Cardiology member countries of atrial fibrillation management: baseline reults of EURObservational Research Programme Atrial Fibrillation (EORPAF) Pilot General Registry. Europace 2014;16:308-19. https://doi.org/10.1093/europace/eut373

Lamberts M, Olesen JB, Ruwald MH, Hansen CM, Karasoy D,Kristensen SL, et al. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention: a nation wide cohort study. Circulation 2012;126:1185-93. https://doi.org/10.1161/CIRCULATIONAHA.112.114967

Gibson CM, Mehran R, Bode C, Halperin J, Verheugt W, Wildgoose P, et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2016;375:2423-34. https://doi.org/10.1056/NEJMoa1611594

Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al;ROCKET-AF Investigators. Rivaroxaban versus warfarin in nonvalvularatrial fibrillation. N Engl J Med 2011;365:883-91. https://doi.org/10.1056/NEJMoa1009638

Cannon CP, Bhatt DL, Oldgren J, Lip GY, Ellis SG, Kimura T,

et al; RE-DUAL PCI Steering Committee and Investigators. Dual

Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation.N Engl J Med 2017;377:1513-24. https://doi.org/10.1056/NEJMoa1708454

Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, MehranR, et al; AUGUSTUS Investigators. Antithrombotic Therapy afterAcute Coronary Syndrome or PCI in Atrial Fibrillation. N Engl JMed 2019;380:1509-24. https://doi.org/10.1056/NEJMoa1817083

Dewilde WJ, Oirbans T, Verheugt FW, Kelder JC, De Smet BJ,Herrman JP, et al; WOEST study investigators. Use of clopidogrelwith or without aspirin in patients taking oral anticoagulant therapyand undergoing percutaneous coronary intervention: an open-label,randomised, controlled trial. Lancet 2013;381:1107-15. https://doi.org/10.1016/S0140-6736(12)62177-1


Refbacks

  • There are currently no refbacks.


Licencia Creative Commons
The documents published in this journal are under the licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.

Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar