Evolving paradigms in antithrombotic therapy for anticoagulated patients undergoing coronary stenting

Figure 1.. Evolution of thromboembolic risk and stent thrombosis in patients with atrial fibrillation and coronary artery disease requiring stent implantation. Thromboembolic risk follows specific temporal dynamics with a higher risk for stent thrombosis seen in the periprocedural and early postoperative phases after stent implantation. A continuous increase in stroke risk can be hypothesized due to pathophysiological mechanisms predisposing to atrial dilation and blood stasis during the course of the disease. AF, atrial fibrillation.

Figure 2.. Design of trials investigating nonvitamin K antagonists in patients with atrial fibrillation undergoing PCI. The figure graphically summarizes the randomized treatment arms across the trials investigating the safety of NOACs use in patients requiring concomitant treatment with anticoagulants and antiplatelet drugs. ASA, aspirin; BMS, bare metal stent; DES, drug-eluting stent; INR, international normalized ratio; NOAC, novel oral anticoagulant; PCI, percutaneous coronary intervention; VKA, vitamin K antagonists. **Creatinine clearance of 15–50 mL/min, body weight ⩽ 60 kg, or use of potent P-glycoprotein inhibitors such as cyclosporine, dronedarone, erythromycin, or ketoconazole. *** If ⩾ 2 criteria amongst: serum creatinine level ⩾ 1.5 mg/dL, age ⩾ 80 years, body weight ⩽ 60 kg

Figure 3.. International consensus documents for the management of antithrombotic therapy in daily clinical practice. DT, dual therapy; OAC, oral anticoagulation; SAPT, single antiplatelet therapy; TT, triple therapy.