Key result
Adding NOACs to antiplatelets post-ACS shows unclear net benefit due to consistently increased bleeding.
Why the study?
Does adding new oral anticoagulants to antiplatelet treatment improve outcomes in patients with atrial fibrillation after acute coronary syndrome?
Does adding new oral anticoagulants to antiplatelet treatment improve outcomes in patients with atrial fibrillation after acute coronary syndrome?
The risk-benefit profile of adding new oral anticoagulants to dual antiplatelet therapy in patients with atrial fibrillation and recent acute coronary syndrome remains uncertain due to increased bleeding risks.
Atrial fibrillation (AF) is the most frequent indication for oral anticoagulation. Dual antiplatelet treatment with aspirin and clopidogrel is an antithrombotic treatment recommended after acute coronary syndrome and/or coronary artery stenting. The evidence for optimal antiplatelet therapy for patients who underwent a long-term treatment based on oral anticoagulation is strong. A direct thrombin inhibitor, dabigatran, as well as direct factor X inhibitors, apixaban and rivaroxaban, are now being commonly used in the prevention of thromboembolic complications of AF. Given the consistent increase in bleeding and the less consistent reduction in ischaemic events, the overall profile of adding new oral anticoagulants to antiplatelet treatment after acute coronary syndrome is unknown.
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Gorczyca−Michta et al. (2013) conducted a review in Atrial fibrillation after acute coronary syndrome. New oral anticoagulants (NOACs) vs. Standard therapy (vitamin K antagonists or antiplatelet drugs alone) was evaluated. Adding new oral anticoagulants to antiplatelet treatment after acute coronary syndrome has an unknown overall clinical profile due to a consistent increase in bleeding and less consistent reduction in ischaemic events.
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