This document provides clinical recommendations for balancing the risks of stroke, stent thrombosis, and major bleeding when choosing antithrombotic therapy for patients with atrial fibrillation undergoing coronary stenting.
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Bleeding risk warrants caution with triple therapy in stented AF patients; leaves open optimal regimen selection.
The optimal regimen of the anticoagulant and antiplatelet therapies in patients with atrial fibrillation who have had a coronary stent is unclear. It is well recognized that "triple therapy" with aspirin, clopidogrel, and warfarin is associated with an increased risk of bleeding. National guidelines have not made specific recommendations, given the lack of adequate data. In choosing the best antithrombotic options for a patient, consideration needs to be given to the risks of stroke, stent thrombosis, and major bleeding. This executive summary describes these risks, provides specific recommendations concerning vascular access, stent choice, concomitant use of proton pump inhibitors, and the use and duration of triple therapy after stent placement, based on the risk assessment.
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Faxon et al. (2011) conducted a review in Atrial fibrillation undergoing coronary stenting. Antithrombotic therapy was evaluated. This executive summary provides recommendations for antithrombotic therapy, vascular access, stent choice, and triple therapy duration in patients with atrial fibrillation undergoing coronary stenting.
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