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- W2950198581 abstract "Approximately 10% of patients undergoing percutaneous coronary intervention (PCI) are long-term users of oral anticoagulation (OAC) due to atrial fibrillation (AF). 1 Sutton NR Seth M Ruwende C et al. Outcomes of patients with atrial fibrillation undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2016; 68: 895-904 Crossref PubMed Scopus (56) Google Scholar , 2 Valgimigli M Bueno H Byrne RA et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018 Jan 14; 39: 213-260https://doi.org/10.1093/eurheartj/ehx419 Crossref PubMed Scopus (1665) Google Scholar In recent years, antithrombotic therapy and the management of AF patients after percutaneous coronary intervention have evolved tremendously. Determining the most suitable antithrombotic treatment in this patient subset is based on the assessment of risk factors for recurrent coronary ischemic events in the form of stent thrombosis and denovo lesions, cardioembolic stroke, and bleeding. 2 Valgimigli M Bueno H Byrne RA et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018 Jan 14; 39: 213-260https://doi.org/10.1093/eurheartj/ehx419 Crossref PubMed Scopus (1665) Google Scholar Dual antiplatelet therapy with aspirin and ADP-receptor blockade is more effective in preventing recurrent coronary ischemic events as compared to anticoagulation only therapy, whereas it is less efficacious in preventing stroke in patients with AF. 3 Karjalainen PP Porela P Ylitalo A et al. Safety and efficacy of combined antiplatelet-warfarin therapy after coronary stenting. Eur Heart J. 2007 Mar; 28: 726-732 Crossref PubMed Scopus (268) Google Scholar From this background – based mainly on observational data – triple therapy (OAC plus ADP receptor blocker plus aspirin) became the guideline-recommended therapy in AF patients undergoing PCI. 2 Valgimigli M Bueno H Byrne RA et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018 Jan 14; 39: 213-260https://doi.org/10.1093/eurheartj/ehx419 Crossref PubMed Scopus (1665) Google Scholar However, results of recent clinical trials resulted in two major shifts shaping the landscape of the management of these patients: 1) WOEST and REDUAL-PCI trials with double therapy (OAC plus ADP receptor blocker) reduced major bleeding rate compared to triple therapy; and 2) PIONEER-AF-PCI and AUGUSTUS-PCI trials with non-vitamin K oral antagonist treatments (NOAC) instead of vitamin K oral antagonist treatment (VKA) as an oral anticoagulant in triple therapy also reduced major bleeds. 4 Dewilde WJ Oirbans T Verheugt FW et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30; 381: 1107-1115https://doi.org/10.1016/S0140-6736(12)62177-1 Abstract Full Text Full Text PDF PubMed Scopus (1307) Google Scholar , 5 Gibson CM Mehran R Bode C et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med. 2016 Dec 22; 375: 2423-2434https://doi.org/10.1056/NEJMoa1611594 Crossref PubMed Scopus (1009) Google Scholar , 6 Cannon CP Bhatt DL Oldgren J et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. N Engl J Med. 2017 Oct 19; 377: 1513-1524https://doi.org/10.1056/NEJMoa1708454 Crossref PubMed Scopus (846) Google Scholar , 7 Lopes RD Heizer G Aronson R et al. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. N Engl J Med. 2019 Mar 17; https://doi.org/10.1056/NEJMoa1817083 Crossref PubMed Scopus (557) Google Scholar These randomized trials have provided pivotal evidence of the safety benefit of NOACs when compared to vitamin K oral antagonist treatment. It is important to note, however, that these trials were powered for the safety outcome of bleeding and not the ischemic events." @default.
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- W2950198581 date "2019-08-01" @default.
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- W2950198581 title "Evolving Field of Long-term Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation" @default.
- W2950198581 doi "https://doi.org/10.1016/j.amjms.2019.04.029" @default.
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