Management of Antithrombotic Therapy in Atrial Fibrillation Patients Undergoing PCI: JACC State-of-the-Art Review

Davide Capodanno, Kurt Huber, Roxana Mehran, Gregory Y.H. Lip, David P. Faxon, Christopher B. Granger, Pascal Vranckx, Renato D. Lopes, Gilles Montalescot, Christopher P. Cannon, Jurien Ten Berg, Bernard J. Gersh, Deepak L. Bhatt, Dominick J. Angiolillo

Research output: Contribution to journalReview articlepeer-review

121 Scopus citations

Abstract

Most patients with atrial fibrillation (AF) and risk factors for stroke require oral anticoagulation (OAC) to decrease the risk of stroke or systemic embolism. This is now best achieved with direct oral anticoagulants that decrease the risk of intracranial bleeding compared with vitamin K antagonists. Of note, approximately 5% to 10% of patients undergoing percutaneous coronary intervention have AF, which complicates antithrombotic therapy in daily practice, because the guidelines recommend that these patients also receive dual antiplatelet therapy (DAPT) to reduce the risk of ischemic complications. However, combining OAC with DAPT, a strategy also known as triple antithrombotic therapy, is known to increase the risk of bleeding compared with the use of OAC or DAPT alone. Studies of direct oral anticoagulants are now emerging that show the favorable safety profile of double antithrombotic therapy with OAC and a P2Y12 inhibitor in comparison with triple antithrombotic therapy including the use of vitamin K antagonists. The scope of this review is to provide an update on this topic as well as to discuss future directions in the management of antithrombotic therapy after percutaneous coronary intervention in AF patients requiring chronic OAC.

Original languageEnglish
Pages (from-to)83-99
Number of pages17
JournalJournal of the American College of Cardiology
Volume74
Issue number1
DOIs
StatePublished - 9 Jul 2019

Keywords

  • atrial fibrillation
  • coronary stenting
  • oral anticoagulant
  • oral antiplatelet

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