Abstract
Acute coronary syndrome and atrial fibrillation are both common and can occur in the same patient. Combination therapy with dual antiplatelet therapy and oral anticoagulation increases risk of bleeding. Where the two conditions coexist, careful consideration is needed to determine the optimal antithrombotic treatment to reduce the risks of future ischaemic events associated with both conditions. Choices can be made in intraprocedural anticoagulation, type and dosing of oral anticoagulant, duration of combination therapy, and selection of P2Y12 inhibitor including genetic testing. This review article provides an overview of the available evidence to support clinicians in finding the delicate balance between antithrombotic efficacy and bleeding risk in patients with acute coronary syndrome and atrial fibrillation.
Highlights
Acute coronary syndrome (ACS) and atrial fibrillation (AF) are both common and can occur in the same patient
A study comparing patients with AF undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) found no difference with regards to in-hospital major bleeding between patients admitted without oral anticoagulation (OAC) and those admitted on chronic vitamin K antagonists (VKA) or nonvitamin K antagonist oral anticoagulants (NOACs) treatment (13.2% vs. 13.0% vs. 11.6%, respectively, p = 0.57) [47]
Patients with concomitant AF and ACS are at higher risk of bleeding, due to the need for combined antithrombotic therapy
Summary
Acute coronary syndrome (ACS) and atrial fibrillation (AF) are both common and can occur in the same patient. Up to 36% of patients with AF have concomitant coronary artery disease (CAD) amongst whom 45% have prior MI [3,4]. Treatment of ACS, with or without percutaneous coronary intervention (PCI), requires the administration of dual antiplatelet therapy (DAPT) to prevent recurrent MI and stent thrombosis (ST) [5,6]. There is a difference in antithrombotic treatment requirements between patients with AF and those with ACS, and where the two conditions coexist, careful consideration is needed to determine the optimal antithrombotic treatment to reduce the risks of future ischaemic events associated with both conditions [8,9].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
