Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome and / or undergoing percutaneous coronary intervention

Miroslav Mihajlovic; Milan Marinkovic; Monika Kozieł; Nebojsa Mujovic; Gregory Y. H. Lip; Tatjana S. Potpara

doi:10.33963/KP.15428

Vol 78, No 6 (2020)

Review paper

Published online: 2020-06-10

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Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome and / or undergoing percutaneous coronary intervention

Miroslav Mihajlovic, Milan Marinkovic, Monika Kozieł, Nebojsa Mujovic, Gregory Y. H. Lip, Tatjana S. Potpara

DOI: 10.33963/KP.15428

Pubmed: 32543800

Kardiol Pol 2020;78(6):512-519.

Vol 78, No 6 (2020)

Review article

Published online: 2020-06-10

Abstract

The use of triple antithrombotic therapy (TAT) consisting of an oral anticoagulant (OAC), aspirin, and a P2Y12 inhibitor in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) and / or undergoing percutaneous coronary intervention (PCI) is associated with a high risk of bleeding. Recently, several randomized clinical trials tested the hypothesis as to whether dual antithrombotic therapy (DAT) regimens (consisting of an OAC and a single antiplatelet drug) may be safer in terms of bleeding events as compared with TAT. They also investigated the role of non–vitamin K antagonist oral anticoagulants (NOACs) as a part of DAT and TAT. The purpose of this review is to provide an overview of available evidence regarding the safety and efficacy of DAT compared with TAT regimens, international guidelines recommendations, knowledge gaps, and unmet needs in the management of patients with AF and ACS and / or undergoing PCI.