Key result
In patients with acute coronary syndrome requiring oral anticoagulation, triple therapy should be limited to 1-6 months followed by dual therapy to minimize bleeding risk, and uninterrupted oral anticoagulation without bridging is recommended during PCI.
This review summarizes ESC consensus recommendations for managing ACS patients on oral anticoagulation, highlighting strategies to balance ischemic and bleeding risks such as short-duration triple therapy and radial access.
A significant number of patients with atrial fibrillation, treated with oral anticoagulants, present with an acute coronary syndrome. Many of these patients have an indication for coronary angiography. The introduction of non-vitamin K antagonist oral anticoagulants (NOACs) and the novel P2Y12 inhibitors has generated new uncertainty about the optimal treatment regimen, whether triple or dual therapy should be given and which is the most beneficial P2Y12 inhibitor (clopidogrel, ticagrelor, prasugrel). In this article, we will summarise the practical advice on the management of acute coronary syndrome patients requiring oral anticoagulants following the recent consensus document of the European Society of Cardiology (ESC) Working Group on Thrombosis in association with the European Heart Rhythm Association (EHRA) and ESC guidelines.
No takes yet. Share an insight, caveat, or question.
Vos et al. (2015) conducted a review in Acute coronary syndrome with indication for oral anticoagulation (e.g., atrial fibrillation). Oral anticoagulation and antiplatelet therapy was evaluated. In patients with acute coronary syndrome requiring oral anticoagulation, triple therapy should be limited to 1-6 months followed by dual therapy to minimize bleeding risk, and uninterrupted oral anticoagulation without bridging is recommended during PCI.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: