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Application of High-Sensitivity Troponin in Suspected Myocardial Infarction Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus Post-Stroke Cardiovascular Complications and Neurogenic Cardiac Injury: JACC State-of-the-Art Review Randomized Comparison Between Radial and Femoral Large-Bore Access for Complex Percutaneous Coronary Intervention Coronary Angiography after Cardiac Arrest without ST-Segment Elevation Predicting Major Adverse Events in Patients With Acute Myocardial Infarction Management of Percutaneous Coronary Intervention Complications: Algorithms From the 2018 and 2019 Seattle Percutaneous Coronary Intervention Complications Conference European Bifurcation Club White Paper on Stenting Techniques for Patients With Bifurcated Coronary Artery Lesions Complete Revascularization with Multivessel PCI for Myocardial Infarction Individualizing Revascularization Strategy for Diabetic Patients With Multivessel Coronary Disease

Review ArticleVolume 74, Issue 1, July 2019

JOURNAL:J Am Coll Cardiol. Article Link

Management of Antithrombotic Therapy in Atrial Fibrillation Patients Undergoing PCI: JACC State-of-the-Art Review

D Capodanno, K Huber, R Mehran et al. Keywords: atrial fibrillation; coronary stenting; oral anticoagulant; oral antiplatelet

ABSTRACT


Most patients with atrial fibrillation (AF) and risk factors for stroke require oral anticoagulation (OAC) to decrease the risk of stroke or systemic embolism. This is now best achieved with direct oral anticoagulants that decrease the risk of intracranial bleeding compared with vitamin K antagonists. Of note, approximately 5% to 10% of patients undergoing percutaneous coronary intervention have AF, which complicates antithrombotic therapy in daily practice, because the guidelines recommend that these patients also receive dual antiplatelet therapy (DAPT) to reduce the risk of ischemic complications. However, combining OAC with DAPT, a strategy also known as triple antithrombotic therapy, is known to increase the risk of bleeding compared with the use of OAC or DAPT alone. Studies of direct oral anticoagulants are now emerging that show the favorable safety profile of double antithrombotic therapy with OAC and a P2Y12 inhibitor in comparison with triple antithrombotic therapy including the use of vitamin K antagonists. The scope of this review is to provide an update on this topic as well as to discuss future directions in the management of antithrombotic therapy after percutaneous coronary intervention in AF patients requiring chronic OAC.