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And now we have the AUGUSTUS … How will it impact on antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention?

  • Andrea Rubboli
    Correspondence
    Corresponding author at: Department of Cardiovascular Diseases - AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121 Ravenna, Italy.
    Affiliations
    Department of Cardiovascular Diseases - AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy
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      Optimal antithrombotic therapy in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention with stent (PCI) should consist of both oral anticoagulation (OAC) and antiplatelet therapy to effectively prevent major adverse cerebral (stroke) and cardiac (death, myocardial infarction, urgent revascularization, and stent thrombosis) ischemic events (MACCE). While the so-called triple therapy with a vitamin K-antagonist (VKA), aspirin and clopidogrel has long been proposed as the default strategy [
      • Rubboli A.
      • Halperin J.L.
      • Airaksinen K.E.
      • Buerke M.
      • Eeckhout E.
      • Freedman S.B.
      • et al.
      Antithrombotic therapy in patients treated with oral anticoagulation undergoing coronary artery stenting. An expert consensus document with focus on atrial fibrillation.
      ], double therapy with a non-vitamin K-antagonist (NOAC) and clopidogrel has subsequently shown a more favorable net clinical effect, being associated with less bleeding events and no apparent increase in MACCE [
      • Gibson C.M.
      • Mehran R.
      • Bode C.
      • Halperin J.
      • Verheugt F.W.
      • Wildgoose P.
      • et al.
      Prevention of bleeding in patients with atrial fibrillation undergoing PCI.
      ,
      • Cannon C.P.
      • Bhatt D.L.
      • Oldgren J.
      • Lip G.Y.H.
      • Ellis S.G.
      • Kimura T.
      • et al.
      Dual antithrombotic therapy with Dabigatran after PCI in atrial fibrillation.
      ]. Which part of this result can be attributed to the type of OAC, i.e., NOAC vs. VKA, and which to the antithrombotic regimen, i.e., double vs. triple, remains to be determined.
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