Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation and coexistent atrial fibrillation – Dual versus triple antithrombotic therapy
Key result
The 2020 ESC Guidelines recommend dual antithrombotic therapy with a NOAC and single antiplatelet therapy as the default strategy up to 12 months for ACS patients with atrial fibrillation.
Population
Patients with acute coronary syndromes presenting without persistent ST-segment elevation and coexistent…
Comparison
Dual antithrombotic therapy with a non-vitamin K… vs Triple antithrombotic therapy or vitamin K…
Design
Editorial
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
JCJean-Philippe ColletCardiologist, Hôpital de la Pitié-Salpêtrière, Paris
“I was very pleased to read this recommendation, because I found it very similar to what we have done during our guidelines. Now we are very consistent, which is good because the evidence is the same.”
DADominick AngiolilloInterventional cardiologist, University of Florida Jacksonville
“We've come a long way over the past decade in fine-tuning our recommendations and being more aligned between the two sides of the Atlantic.”
Implication
This commentary reinforces the 2020 ESC Guidelines recommending NOAC-based dual antithrombotic therapy as the default strategy for NSTE-ACS patients with atrial fibrillation undergoing PCI.
Key Points
- To summarize updated European clinical guideline recommendations regarding the choice between dual and triple antithrombotic therapy in patients with non-ST-segment elevation acute coronary syndromes and coexisting atrial fibrillation.
- Reviewed and integrated findings from landmark clinical trials over a five-year period investigating combinations of anticoagulants and antiplatelet drugs.
- Harmonized treatment protocols between the 2020 ESC Non-ST-Segment Elevation Acute Coronary Syndrome guidelines and joint ESC/EACTS Atrial Fibrillation guidelines.
- Non-vitamin K oral anticoagulants are preferred over vitamin K antagonists for patients undergoing percutaneous coronary intervention who require long-term oral anticoagulation.
- Dual antithrombotic therapy combining a non-vitamin K oral anticoagulant and a single antiplatelet drug is the default strategy for up to 12 months following up to one week of triple therapy.
- Triple antithrombotic therapy may be extended up to one month only when ischemic thrombotic risk outweighs the patient's bleeding risk.
Structured PICO
P
Population
Patients with acute coronary syndromes presenting without persistent ST-segment elevation and coexistent atrial fibrillation undergoing percutaneous coronary intervention with indication for long-term oral anticoagulation
I
Intervention
Dual antithrombotic therapy with a non-vitamin K oral anticoagulant (NOAC) and single antiplatelet therapy
C
Comparator
Triple antithrombotic therapy or vitamin K antagonists
This commentary reinforces the 2020 ESC Guidelines recommending NOAC-based dual antithrombotic therapy as the default strategy for NSTE-ACS patients with atrial fibrillation undergoing PCI.
Cite This Study
Collet et al. (2020) conducted an editorial in Acute coronary syndromes without persistent ST-segment elevation and coexistent atrial fibrillation. Dual antithrombotic therapy with a NOAC and single antiplatelet therapy vs. Vitamin K antagonists or prolonged triple antithrombotic therapy was evaluated. The 2020 ESC Guidelines recommend dual antithrombotic therapy with a NOAC and single antiplatelet therapy as the default strategy up to 12 months for ACS patients with atrial fibrillation.