Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary Syndrome

Abstract

Acute coronary syndrome and atrial fibrillation are both common and can occur in the same patient. Combination therapy with dual antiplatelet therapy and oral anticoagulation increases risk of bleeding. Where the two conditions coexist, careful consideration is needed to determine the optimal antithrombotic treatment to reduce the risks of future ischaemic events associated with both conditions. Choices can be made in intraprocedural anticoagulation, type and dosing of oral anticoagulant, duration of combination therapy, and selection of P2Y12 inhibitor including genetic testing. This review article provides an overview of the available evidence to support clinicians in finding the delicate balance between antithrombotic efficacy and bleeding risk in patients with acute coronary syndrome and atrial fibrillation.

Diagnosis and Management of Acute Coronary Syndrome: What is New and Why? Insight From the 2020 European Society of Cardiology Guidelines

“…With respect to patient requiring long-term oral anticoagulant, several large RCT including a majority of patients presenting with an ACS, evaluated DAT regimen based on non-vitamin K antagonist oral anticoagulant (NOAC) + P2Y 12 versus triple antithrombotic therapy (TAT) with vitamin K antagonist (VKA) +aspirin+P2Y 12 receptor inhibitors and demonstrated a significant reduction of the risk of bleeding complication with the former (Table 4) [58][59][60][61][62][63][64][65].…”