Abstract
The ideal antithrombotic management in patients with atrial fibrillation undergoing elective percutaneous coronary intervention or in acute coronary syndrome has not been definitively established yet. Dual antiplatelet therapy (aspirin and P2Y12 receptor inhibitors) reduces stent thrombosis and subsequent ischemic events. In turn, the presence of atrial fibrillation requires oral anticoagulation to prevent stroke and other thromboembolic complications. However, the combination of these two treatments, known as triple therapy, increases the risk of severe bleeding, with a negative prognostic impact. The use of direct anticoagulants, which reduce bleeding rates compared to warfarin, together with the maintenance of only one antiplatelet agent (P2Y12 inhibitors), known as dual therapy, may be a safer alternative in these patients. In this article, we reviewed several randomized studies comparing triple versus dual therapy, as well as meta-analyses with such studies, and the approaches suggested by the most recent guidelines, discussing the advantages and disadvantages of these treatments, in terms of safety and efficacy in this important and growing subgroup of patients.
Highlights
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias today, and its prevalence increases with age and the presence of risk factors, such as diabetes mellitus, hypertension (HTN) and dyslipidemia, being associated with increased mor-J Transcat Intervent. 2021;29:eA202015tality.[1]
percutaneous coronary intervention (PCI) involves the use of dual antiplatelet therapy (DAPT), which is an association of aspirin with one of the P2Y12 receptor inhibitors for varying periods, depending on the clinical scenario and the anatomical complexity of the coronary artery disease (CAD)
dual therapy (DT) was associated with a marginal increase in myocardial infarction (MI) (3.6% versus 3.0%; risk reduction of 1.22; 95%CI 0.99-1.52; p=0.07) and a significantly higher risk of stent thrombosis (1.0% versus 0.6%; risk reduction of 1.59; 95%CI 1.01-2.50; p=0.04) compared to triple therapy (TT) with warfarin
Summary
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias today, and its prevalence increases with age and the presence of risk factors, such as diabetes mellitus, hypertension (HTN) and dyslipidemia, being associated with increased mor-. The incidence of AF in ACS ranges from 2% to 23%, and the presence of AF, by itself, increases the risk of ACS with or without ST-segment elevation.[3] PCI involves the use of dual antiplatelet therapy (DAPT), which is an association of aspirin with one of the P2Y12 receptor inhibitors (clopidogrel, ticagrelor and prasugrel) for varying periods, depending on the clinical scenario and the anatomical complexity of the CAD This therapy aims to reduce stent thrombosis and its major clinical consequences, namely death and acute myocardial infarction (MI).[4,5,6]
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