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The Times They Are A-Changin´: Antithrombotic strategies in patients with acute coronary syndrome undergoing coronary stenting who have concomitant atrial fibrillation

Published:April 29, 2021DOI:https://doi.org/10.1016/j.ejim.2021.04.008
      Atrial fibrillation (AF) is a highly prevalent condition associated with an increased risk of cardioembolic strokes. Consequently, oral anticoagulation therapy has been established as a cornerstone in the clinical management of patients with AF. However, in patients with an indication for antiplatelet therapy following stent implantation for an acute coronary syndrome (ACS), the optimal antithrombotic strategy in anticoagulated patients remains debated, due to the increased risk of bleeding associated with the use of antiplatelets in dual antithrombotic therapy (DAT) or triple antithrombotic therapy (TAT) regimens. Recently, the ESC 2020 NSTEMI and 2020 AF guidelines have recommended that TAT should be used for a limited time-period and, for the majority of these patients, only during the hospital stay [
      • Hindricks G
      • Potpara T
      • Dagres N
      • Arbelo E
      • Bax JJ
      • Blomstrom-Lundqvist C
      • et al.
      2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).
      ,
      • Collet JP
      • Thiele H
      • Barbato E
      • Barthelemy O
      • Bauersachs J
      • Bhatt DL
      • et al.
      2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.
      ].

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      References

        • Hindricks G
        • Potpara T
        • Dagres N
        • Arbelo E
        • Bax JJ
        • Blomstrom-Lundqvist C
        • et al.
        2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2021; 42: 373-498https://doi.org/10.1093/eurheartj/ehaa612
        • Collet JP
        • Thiele H
        • Barbato E
        • Barthelemy O
        • Bauersachs J
        • Bhatt DL
        • et al.
        2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.
        Eur Heart J. 2020; : ehaa575https://doi.org/10.1093/eurheartj/ehaa575
        • De Luca L
        • Di Lenarda A
        • Rubboli A
        • Bolognese L
        • Gonzini L
        • Fortuni F
        • et al.
        Post-discharge antithrombotic management and clinical outcomes of patients with new-onset or pre-existing atrial fibrillation and acute coronary syndromes undergoing coronary stenting: follow-up data of the MATADOR-PCI study.
        Eur J Int Med. 2021; https://doi.org/10.1016/j.ejim.2021.03.029
        • De Luca L
        • Rubboli A
        • Bolognese L
        • Gonzini L
        • Urbinati S
        • Murrone A
        • et al.
        Antithrombotic management of patients with acute coronary syndrome and atrial fibrillation undergoing coronary stenting: a prospective, observational, nationwide study.
        BMJ Open. 2020; 10e041044https://doi.org/10.1136/bmjopen-2020-041044
        • Valgimigli M
        • Bueno H
        • Byrne RA
        • Collet JP
        • Costa F
        • Jeppsson A
        • 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; 39: 213-260https://doi.org/10.1093/eurheartj/ehx419
        • Lip GYH
        • Collet JP
        • Haude M
        • Byrne R
        • Chung EH
        • Fauchier L
        • et al.
        2018 Joint European consensus document on the management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous cardiovascular interventions: a joint consensus document of the European Heart Rhythm Association (EHRA), European Society of Cardiology Working Group on Thrombosis, European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA).
        Europace. 2019; 21: 192-193https://doi.org/10.1093/europace/euy174
        • Angiolillo DJ
        • Goodman SG
        • Bhatt DL
        • Eikelboom JW
        • Price MJ
        • Moliterno DJ
        • et al.
        Antithrombotic therapy in patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention: a North American perspective-2018 update.
        Circulation. 2018; 138: 527-536https://doi.org/10.1161/CIRCULATIONAHA.118.034722
        • Connolly SJ
        • Pogue J
        • Hart RG
        • Hohnloser SH
        • Pfeffer M
        • Chrolavicius S
        • et al.
        Effect of clopidogrel added to aspirin in patients with atrial fibrillation.
        N Engl J Med. 2009; 360: 2066-2078https://doi.org/10.1056/NEJMoa0901301