Antithrombotic therapy after percutaneous coronary intervention in anticoagulated patients: a fine balance between thrombosis and bleeding

Oral anticoagulation (OAC), usually with vitamin K antagonists (such as warfarin, target international normalized ratio [INR] 2 3, or higher with some prosthetic valves) is the proven therapy and recommended treatment for a wide range of patients at risk of thromboembolic events, including atrial fibrillation (AF), mechanical heart valves, deep vein thrombosis, pulmonary embolism and left ventricular thrombi. These conditions are common, and with an increasing average life expectancy, some of these conditions (especially AF) are increasing in prevalence [Lip and Lim, 2007; Kannel et al. 1998]. Furthermore, pathologies such as AF are commonly associated with coronary artery disease: approximately 20 30% of AF patients have concomitant coronary artery disease [Nieuwlaat et al. 2005]. Such patients may present with acute coronary syndrome (ACS) and/or undergo percutaneous coronary intervention (PCI), often with stenting (PCI-S).