AF anticoagulation in ACS

  • سال انتشار: 1397
  • محل انتشار: دومین کنگره بین المللی سندرم های کرونری حاد ایران
  • کد COI اختصاصی: ICACSMED02_028
  • زبان مقاله: انگلیسی
  • تعداد مشاهده: 428
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نویسندگان

SH Madadi

چکیده

Patients with mechanical heart valves, a prior systemic thromboembolic event and atrial fibrillation/flutter (AF), often require long-term anticoagulation. About 20% to 30% of these patients have concomitant ischemic heart disease requiring percutaneous coronary intervention and stent implantation (PCI). This would mandate the use of dual antiplatelet therapy (DAPT) (aspirin and an adenosine diphosphate antagonist) for prevention of stent thrombosis and adverse events following PCI. It is often a clinical dilemma, whether to use dual therapy (DT) with either oral anticoagulant (OAC) and single antiplatelet therapy (SAPT) or DAPT or triple therapy (TT) with OAC and DAPT in these patients.Although primary intent of TT is to decrease the incidence of major adverse cardiac events (MACE), especially stent thrombosis, it has been found to be associated with a high annual risk of bleeding , which in turn is strongly associated with recurrent hospitalization and increased morbidity and mortality . There is also emerging evidence that use of DAPT in these patients is associated with similar outcomes to TT with less bleeding. The efficacy of TT in patients on OAC needing PCI has never been proven. This combination increases bleeding risk, which can result in adverse patients’ outcomes. New evidence indicates the great potential of the combination of OAC and clopidogrel without aspirin to improve clinical outcomes in comparison with triple therapy. Therefore, OAC combined with clopidogrel seems to be a reasonable alternative to triple therapy in patients on long-term OAC who undergo PCI.

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