Does novel dual therapy (NOAC + SAPT) reduce bleeding risk while retaining ischemic benefits compared to conventional triple therapy in patients with atrial fibrillation undergoing PCI?
Novel dual therapy (NOAC + SAPT) represents a paradigm shift in managing anticoagulated AF patients undergoing PCI, offering a strategy to reduce bleeding risks associated with conventional triple therapy without compromising ischemic protection.
Patients with atrial fibrillation (AF) on long-term oral anticoagulation (OAC) either have underlying coronary artery disease or suffer from acute coronary syndromes necessitating a percutaneous coronary intervention (PCI). In such a scenario, an amalgamation of antiplatelet and antithrombotic therapy (conventionally called as "triple therapy") is obligatory for preventing coronary ischemia and stroke. But such ischemic benefits are accrued at the cost of increased bleeding. We also now know that bleeding events following PCI are related to increased mortality. Balancing the bleeding and ischemic risks is often a clinical dilemma. With the advent of novel oral anticoagulants (NOAC's) with preserved efficacy and attenuated bleeding rates, anticoagulation in AF is undergoing paradigm shift. The spotlight is now shifting from conventional triple therapy (vitamin-K antagonist + dual antiplatelet therapy VKA + DAPT) to novel dual therapy (NOAC + single antiplatelet therapy SAPT) in situation of anticoagulated AF patients undergoing PCI. Such a strategy aims to ameliorate the higher bleeding risk with conventional VKA's while retaining the ischemic benefits. In this review, we briefly discuss the need for combination therapy, trials of novel dual therapy, strategies for mitigating bleeding, the current guidelines, and the future perspectives in AF undergoing PCI with stent(s).
Pradhan et al. (Thu,) studied this question.