Why the study?
Evidence that anticoagulation alone without antiplatelet therapy adequately reduces the attritional risk of stent thrombosis beyond 1 year post-PCI in patients with AF is sparse, despite guideline recommendations.
Does long-term anticoagulation alone without antiplatelet therapy prevent stent thrombosis and reduce bleeding in patients with atrial fibrillation 1 year post-percutaneous coronary intervention?
Does long-term anticoagulation alone without antiplatelet therapy prevent stent thrombosis and reduce bleeding in patients with atrial fibrillation 1 year post-percutaneous coronary intervention?
This review highlights the sparse evidence supporting the safety of current guideline recommendations to discontinue antiplatelet therapy 12 months post-PCI in patients with AF, raising concerns about the risk of very late stent thrombosis.
Answers are grounded in this paper and cite their sources.
Urges caution applying 12-month antiplatelet discontinuation guidelines in AF post-PCI; leaves open need for dedicated trials on anticoagulation monotherapy.
The prevalence of AF in patients with coronary artery disease is high. The guidelines from many professional groups, including the European Society of Cardiology, American College of Cardiology/American Heart Association and Heart Rhythm Society, recommend a maximum duration of 12 months of combination single antiplatelet and anticoagulation therapy in patients who undergo percutaneous coronary intervention and who have concurrent AF, followed by anticoagulation alone beyond 1 year. However, the evidence that anticoagulation alone without antiplatelet therapy adequately reduces the well-documented attritional risk of stent thrombosis after coronary stent implantation is relatively sparse, particularly given that very late stent thrombosis (>1 year from stent implantation) is the commonest type. By contrast, the elevated risk of bleeding from combined anticoagulation and antiplatelet therapy is clinically important. The aim of this review is to assess the evidence for long-term anticoagulation alone without antiplatelet therapy 1 year post-percutaneous coronary intervention in patients with AF.
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Abdulrahman et al. (2023) studied this question.
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