Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome in the real world: Data from the Berlin AFibACS Registry

Abstract

Background: Guidelines for the management of atrial fibrillation (AFib) recommend antithromboembolic treatment strategies for patients with AFib and acute coronary syndrome (AFibACS (Cardiol J 2014; 21, 5: 465-473)

Post myocardial infarction and atrial fibrillation: Thromboprophylaxis and risk stratification using the CHA2DS2-VASc score

“…A greater emphasis on the use of appropriate OAC would help prevent death and reduce thromboembolic risk. This is further emphasized by the findings from Lau et al [9], demonstrating the increased incidence of AF and stroke among STEMI survivors. The two articles in this journal also highlight the need for more trials related to the use of dual or triple therapy in the prevention of ischemic stroke in AF patients receiving coronary stents, as well as the intensity of surveillance in post ACS patients to detect new-onset AF.…”

“…The findings from Lau et al [9] have highlighted the increased prevalence of AF and ischemic stroke among post-STEMI survivors, and emphasized the need for greater vigilance and better surveillance for new onset AF among this at-risk patient group. Nonetheless, once AF has been detected, the shift should be to identify those who will not benefit from OAC and after individualized stratification of bleeding risk, offer the most appropriate antithrombotic treatment to the rest [14].…”

“…More importantly, Lau et al [9] demonstrated that those with new-onset AF are more likely to have higher pre-event CHADS 2 and CHA 2 DS 2 -VASc scores. Both CHADS 2 and CHA 2 DS 2 -VASc scores predicted a greater incidence of AF, with a c-statistics of 0.632 and 0.676, respectively.…”

“…First, Maier et al [8] used the Berlin metropolitan registries to investigate the use of antiplatelet agents and OAC amongst AF patients who have experienced ACS. The second article by Lau et al [9] utilized a Hong Kong registry to investigate the possibility of using CHADS 2 and CHA 2 DS 2 -VASc score to predict new-onset AF among ST elevation myocardial infarction (STEMI) survivors.…”

“…In the second article, Lau et al [9] utilized a Hong Kong local cardiac registry to follow 607 consecutive STEMI survivors, who had no known prior AF, for a period of 63 months, with the aim of identifying new-onset AF or stroke in this patient group. With this approach, 83 new-onset AF and 29 ischemic strokes were noted during the follow-up period.…”