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Antithromboembolic strategies in atrial fibrillation: A review.
Cardiol J. 2016 Jan 18;
Authors: Cocco G, Amiet P, Jerie P
Abstract
Oral anticoagulation is highly effective for stroke prevention in high-risk-patients with atrial fibrillation. AF is also a risk for dementia, and effective OAC reduces the risk of dementia. Up to 30% of patients with atrial fibrillation have a coronary artery disease and antiplatelets are used to avoid thrombotic complications]. Patients with atrial fibrillation oft have an acute coronary syndrome und undergo a percutaneous intervention with stent-implantation. These patients require a triple therapy, i.e. the combination of oral anticoagulation with dual-anti-platelet therapy. It is obvious that OAC may induce bleeding with potentially deleterious effects on mortality. Even the occurrence of minor bleeding is problematic. The review describes available data on used antithromboembolic regimens in patients treated with oral anticoagulation (vitamin K antagonists and non-vitamin K antagonists) who need a triple therapy (i.e. anticoagulation and antiplatelets). Most data are from patients who were treated for an acute coronary syndrome and cannot be directly extrapolated for patients with atrial fibrillation. The impact of used stents and novel P2Y12 antagonist-antiplatelets and duration of triple therapy is discussed. Often some high-risk patients with atrial fibrillation would need anticoagulation but cannot be given this therapy because of excessive bleeding risks or contraindicating comorbidities: in these patients left atrial appendage closure with an occluding device can be used as an alternative to antithromboembolic therapy- The unavoidable antithromboembolic triple therapy carries a strong potential for bleeding events, which increase mortality. We have many data and several recommendations are offered. . Nonetheless, we lack solid data on the best antithromboembolic regimen in patients with atrial fibrillation who need anticoagulation and antiplatelets.
PMID: 26779967 [PubMed - as supplied by publisher]