Antithrombotic strategies for preventing long-term major adverse cardiovascular events in patients with non-valvular atrial fibrillation who undergo percutaneous coronary intervention

Publikation: Forskning - peer reviewTidsskriftartikel

DOI

  • Manan Pareek
    Manan Pareekb Cardiology Section, Department of Internal Medicine , Holbaek Hospital , Holbaek , Denmark.
  • Deepak L Bhatt
    Deepak L Bhatta Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School , Boston , MA , USA.
  • Jurriën M ten Berg
    Jurriën M ten Bergc Department of Cardiology , St. Antonius Hospital , Nieuwegein , The Netherlands.
  • Steen D Kristensen
  • Erik L Grove

INTRODUCTION: Balancing the risk of recurrent ischemia and bleeding among patients with non-valvular atrial fibrillation who undergo percutaneous coronary intervention (PCI) is challenging. Postprocedural antithrombotic therapy aims to reduce the risk related to coronary artery disease, stent placement, and atrial fibrillation, with acceptable risks of bleeding. Areas covered: This review summarizes evidence and recommendations related to long-term antithrombotic strategies in such patients. An overview of the findings from recent meta-analyses and select observational studies is provided, and important completed and ongoing randomized trials are described in detail. Recommendations pertaining to treatment intensity and duration, including the choice of specific anticoagulant and antiplatelet agents, are given. Expert opinion: Triple therapy (oral anticoagulation with dual antiplatelet therapy) is associated with an increased bleeding risk compared with double therapy (oral anticoagulation with a single antiplatelet agent), but double therapy does not appear to be associated with an increased risk of recurrent ischemia or death. Completed trials make a compelling case for double therapy with clopidogrel, not aspirin, when compared with full-intensity triple antithrombotic therapy. We believe that double therapy with an anticoagulant and clopidogrel should generally be favored instead of triple antithrombotic therapy.

OriginalsprogEngelsk
TidsskriftExpert Opinion on Pharmacotherapy
Vol/bind18
Tidsskriftsnummer9
Sider (fra-til)875-883
Antal sider9
ISSN1465-6566
DOI
StatusUdgivet - jun. 2017

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