Antithrombotic treatment in patients with atrial fibrillation after stent implantation: is it prime time for the dual strategy in routine practice?
Állami Szívkórház, Balatonfüred
Városmajori Szív- és Érgyógyászati Klinika, Budapest
Dual antiplatelet therapy (DAPT) is recommended to prevent stent thrombosis and recurrent myocardial infarction depending on the type of stent and the clinical presentation for 1 (elective, BMS), 6 (elective, DES) or 12 months (acute coronary syndrome) after PCI. However, DAPT is not effective in preventing stroke in patients with atrial fibrillation and therefore, DAPT plus oral anticoagulation may give the maximal efficacy to prevent both cerebrovascular and cardiovascular events after PCI. During recent years, several lines of evidence surfaced to show that such combinations of DAPT and anticoagulation significantly increase the risk of bleeding and therefore, it is a clinically relevant aim to limit the duration of triple therapy. In addition, the availability of non-Vitamin K antagonist-type oral anticoagulants (NOAC-s) gave further possibilities to use simplified therapeutic protocols in this demanding patient population. The main aim of this review is to demonstrate the appropriate use of NOAC-s based on the most recent clinical evidence and guideline recommendations in patients with atrial fibrillation after PCI.