Elderly patient with atrial fibrillation and coronary risks

Abstract

The incidence of atrial fibrillation (AF) and coronary heart disease (CHD) increases with age. Obviously, this is largely due to the coincidence of risk factors for the occurrence and progression of AF and risk factors for the occurrence and progression of atherosclerosis, including coronary atherosclerosis. Vitamin K antagonists, which are necessary for stroke prevention in patients with AF, are also reported to be able to prevent thrombotic complications of coronary atherosclerosis. No studies specifically designed to compare direct oral anticoagulants (DOACs) and vitamin K antagonists in the prevention of coronary thrombosis have been conducted, However, analysis of the results of randomized controlled trials ARISTOTLE, AUGUSTUS, PIONEER AF-PCI, REDUAL PCI, RE-LY and ROCKET AF indicates that in general DOACs are not inferior to warfarin in the ability to protect patients with AF from myocardial infarction and stent thrombosis. Accordingly, in stable patients with non-valvular AF (who have not suffered an acute coronary syndrome in the next 1 year or planned coronary stenting in the next 6 months) they can be used as monotherapy, without simultaneous administration of antiaggregants. Taking into account the data obtained in patients with sinus rhythm who recently had acute coronary syndrome in the randomized controlled trial ATLAS-ACS 2, as well as with stable atherosclerotic disease in the randomized controlled trial COMPASS, the greatest evidence base in the prevention of coronary complications has been accumulated with rivaroxaban. At the same time, the results of the COMPASS study, as well as analysis of daily medical practice indicate its additional benefits in patients with peripheral atherosclerosis.