Sukhdeep Bhogal1, Mohamad Alkhouli2, Christopher J White3, Steven Bailey4, Mamas Mamas5, Elias Haddad6, Timir K Paul7. 1. Medstar Washington Hospital Center, Washington, DC, USA. 2. Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA. 3. Department of Cardiovascular Diseases, The Ochsner Clinical School, Ochsner Medical Center, University of Queensland, AU, John Ochsner Heart & Vascular Institute, New Orleans, LA, USA. 4. Lousiana State University-Shreveport, Shreveport, LA, USA. 5. Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK. 6. University of Tennessee at Nashville, 4230 Harding Pike, Nashville, TN, 37025, USA. 7. University of Tennessee at Nashville, 4230 Harding Pike, Nashville, TN, 37025, USA. tpaul5@uthsc.edu.
Abstract
PURPOSE OF REVIEW: The optimal antithrombotic strategy in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) remains the subject of controversy. In this article, we review the current evidence for the use of triple therapy in acute coronary syndrome (ACS) patients. RECENT FINDINGS: The recently published trials of AF patients undergoing PCI have shown that combination of non-vitamin K oral anticoagulants (NOACs) with an antiplatelet agent is either superior or non-inferior to vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT) in reducing bleeding complications with no difference in regard to thromboembolic events. Currently, the use of dual therapy (preferably with a NOAC and clopidogrel) is recommended over triple therapy in these patients. The optimal duration should be guided by the assessment of an individual's risk of thrombosis and bleeding events.
PURPOSE OF REVIEW: The optimal antithrombotic strategy in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) remains the subject of controversy. In this article, we review the current evidence for the use of triple therapy in acute coronary syndrome (ACS) patients. RECENT FINDINGS: The recently published trials of AF patients undergoing PCI have shown that combination of non-vitamin K oral anticoagulants (NOACs) with an antiplatelet agent is either superior or non-inferior to vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT) in reducing bleeding complications with no difference in regard to thromboembolic events. Currently, the use of dual therapy (preferably with a NOAC and clopidogrel) is recommended over triple therapy in these patients. The optimal duration should be guided by the assessment of an individual's risk of thrombosis and bleeding events.
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