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Atrial fibrillation with percutaneous coronary intervention: Navigating the minefield of antithrombotic therapies

      Highlights

      • This review provides insights into contemporary antithrombotic options for patients with atrial fibrillation undergoing percutaneous coronary intervention.
      • Nuances between key international guidelines regarding recommendations for these patients are discussed.
      • Evidence supports a dual antithrombotic pathway approach as the recommended therapy for the majority of these patients. If triple antithrombotic therapy is chosen, its duration should be kept as short as possible.

      Abstract

      This review aims to provide insights into contemporary therapeutic options for the treatment of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) and compares current international guidelines. AF is a common cardiac arrhythmia and a major risk factor for stroke. The risk of stroke can be reduced with the use of oral anticoagulant (OAC) therapy. However, for patients with AF, PCI necessitates the use of combined antithrombotic therapies (OAC and antiplatelet therapies) to reduce thrombotic coronary complications. Optimal combinations and durations of OAC and/or antiplatelet therapy remains an area of clinical debate. Nuances exist within the current guidelines regarding duration and combination of antithrombotic therapy for AF patients requiring PCI. However, consensus was found across the following key points: (i) recent evidence supports a preferred role for a dual antithrombotic approach (OAC plus 1 antiplatelet); (ii) limited use of triple antithrombotic therapy is recommended across all guidelines for patients where the ischemic risk outweighs the risk of bleeding, with the duration to be kept as short as possible; and (iii) lifelong management using monotherapy with an OAC from 12 months post PCI is recommended for stable patients across all guidelines.

      Keywords

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