Why the study?
About 20% of AF patients require coronary stenting and need optimal antithrombotic therapy balancing bleeding and ischemic risks.
Does NOAC-based dual antithrombotic therapy reduce bleeding compared to VKA-based triple antithrombotic therapy in atrial fibrillation patients undergoing percutaneous coronary intervention?
Does NOAC-based dual antithrombotic therapy reduce bleeding compared to VKA-based triple antithrombotic therapy in atrial fibrillation patients undergoing percutaneous coronary intervention?
NOAC-based dual antithrombotic therapy reduces bleeding compared to VKA-based triple therapy in AF patients undergoing PCI, though a short 14-30 day course of triple therapy is recommended to prevent early stent thrombosis.
May guide antithrombotic choices in AF patients post-PCI; leaves open optimal regimens and durations for prospective validation.
About 20% of all atrial fibrillation (AF) patients develop coronary artery disease, which requires coronary stenting [percutaneous coronary intervention (PCI)]. Thus, this subcohort of AF patients may require aggressive antithrombotic therapy encompassing vitamin K antagonist (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC) plus aspirin and a P2Y12 inhibitor. At present, four clinical Phase IIIb trials using dabigatran, rivaroxaban, apixaban, or edoxaban, were published. These studies assessed the impact of NOACs as a part of DAT therapy vs. triple therapy. Compared with triple therapy, NOAC-based DAT has been shown to be associated with reduced major bleeding as well as intracranial haemorrhages. The benefit, however, is somewhat counterbalanced by a higher risk of stent-related ischaemia during the early phase of dual therapy. Thus, triple therapy after stenting is appropriate for at least 14 days with a maximum of 30 days. Thereafter, DAT including a NOAC is the therapy of choice in AF PCI patients to reduce the risk of bleeding during a 1 year of follow-up compared to VKA-based regimes. The present review summarizes the published study results and demonstrates differences in trial design and reported outcomes.
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Goette et al. (2020) studied this question.
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