Controversies in Antiplatelet and Anticoagulation Therapy in Patients Presenting with Acute Coronary Syndrome

Phillips, Colin T.; Gavin, Michael C.

doi:10.15420/usc.2017:8:1

Cited by 2 publications

(1 citation statement)

References 48 publications

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“…Warfarin plus aspirin reduce the risk of ischaemic events after ACS with or without stenting when compared to aspirin alone. However, oral VKA is prone to interaction with food and drugs, needs laboratory monitoring, and increase the bleeding events [68,69]. Thus, the long-term use of warfarin in such patients is not recommended [70].…”

Section: Areas Of Uncertainty Concerning Dat or Tat Regimens Post Procedures And Post Dischargementioning

confidence: 99%

Management of antithrombotic therapy in patients with atrial fibrillation and acute coronary syndromes

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Țînț²,

Petriş³

2021

Rev. Cardiovasc. Med.

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If atrial fibrillation (AF) and acute coronary syndrome (ACS) coexist, they should be treated with combined antithrombotic therapy. To reduce the risk of bleeding while maintaining the desired antithrombotic effect, choices should be made for each patient according to the balance between the bleeding and the thrombotic risk. There are many ways to select the type and dose of the oral anticoagulant (OAC) and P2Y12 inhibitors. As a rule of thumb, aspirin and P2Y12 inhibitors should be recommended to all patients. The duration of this combination therapy is a matter of debate; available data promote an initial period of one to four weeks of triple antithrombotic association with aspirin and P2Y12 inhibitors (clopidogrel in the absence of high ischaemic risk) and preferable direct oral anticoagulants (DOACs). On discontinuing aspirin, double therapy with P2Y12 inhibitors and a DOAC provides similar efficacy and superior safety for many patients on ACS medical or interventional treatment, especially if the risk of bleeding is high and that of thrombosis is low. Further studies are needed to clarify the concerns for a slight augmentation in the number of ischaemic cases (myocardial infarction and stent thrombosis) with double antithrombotic regimen in patients at high ischaemic risk.

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Section: Areas Of Uncertainty Concerning Dat or Tat Regimens Post Procedures And Post Dischargementioning

confidence: 99%

Management of antithrombotic therapy in patients with atrial fibrillation and acute coronary syndromes

Pop¹,

Țînț²,

Petriş³

2021

Rev. Cardiovasc. Med.

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Anticoagulation in Acute Coronary Syndrome: Review of Major Therapeutic Advances

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Matei²,

Petriş

2019

American Journal of Therapeutics

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Background: In patients with acute coronary syndrome (ACS), a persistent hypercoagulable state has been demonstrated and antithrombin therapy in addition to platelet inhibition has been proposed. Areas of Uncertainty: Vitamin K antagonists (VKAs) were used as oral anticoagulant (OAC) therapy and produced mixed results whereas trials are still ongoing with non-vitamin K OACs (NOACs). Data Sources: A literature search regarding benefits and risks of different OAC therapies in ACS was conducted through MEDLINE and EMBASE (last 20 years until September 2018). Therapeutic Advances: Patients receiving dual antiplatelet therapy (DAPT) in combination with NOAC are to be considered at high bleeding risk. Rivaroxaban 2.5 mg BID in triple therapy with DAPT, rivaroxaban 15 mg, or dabigatran 110/150 mg BID in dual therapy with P2Y12 inhibitor (mainly clopidogrel) is safer in terms of bleeding risk than triple therapy with VKA plus DAPT. The reduction in ischemic events by NOACs was most promising when added to single antiplatelet therapy. Ongoing trials with apixaban and edoxaban could clarify whether dual therapy NOACs with P2Y12 inhibitor sufficiently protect against stent thrombosis or myocardial infarction and are safer in terms of bleeding risk than a dual therapy with a VKA and clopidogrel. In the absence of randomized trials, it is unknown whether dual therapy with NOAC and aspirin could be an alternative to NOAC and a P2Y12 inhibitor. Thus, the overall benefit of adding NOAC to antiplatelet treatment after ACS in patients without clear indication for long-term OAC is still unknown. Conclusions: Different OACs have been tested as antithrombotic therapy after ACS in combination with single or DAPT and led to a modest reduction in ischemic events. Further studies evaluating NOACs in combination with single antiplatelet therapy or shorter duration of triple antithrombotic therapy are warranted.

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Controversies in Antiplatelet and Anticoagulation Therapy in Patients Presenting with Acute Coronary Syndrome

Cited by 2 publications

References 48 publications

Management of antithrombotic therapy in patients with atrial fibrillation and acute coronary syndromes

Management of antithrombotic therapy in patients with atrial fibrillation and acute coronary syndromes

Anticoagulation in Acute Coronary Syndrome: Review of Major Therapeutic Advances

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