Key result
NOACs may offer a safer alternative to warfarin in AF and CAD requiring antiplatelets.
Why the study?
Robust evidence is lacking for some guideline recommendations on oral anticoagulation and antiplatelet therapy combinations, especially with new oral anticoagulants and antiplatelets in patients with atrial fibrillation after coronary stent implantation.
An individualized approach balancing ischemic and bleeding risks is necessary for patients with AF and CAD, with novel oral anticoagulants potentially offering safer alternatives to warfarin in combination regimens.
Requires individualized ischemic-bleeding risk assessment in AF-CAD; leaves open need for dedicated RCTs of NOACs versus warfarin.
Anticoagulation represents the mainstay of therapy for most patients with atrial fibrillation. Patients on oral anticoagulation often require concomitant antiplatelet therapy, mostly because of coronary artery disease. After coronary stent implantation, dual antiplatelet therapy is necessary. However, the combination of oral anticoagulation and antiplatelet therapy increases the bleeding risk. Risk scores such as the CHA(2)DS(2)-Vasc score and the HAS-BLED score help to identify both bleeding and stroke risk in individual patients. The guidelines of the European Society of Cardiology provide a rather detailed recommendation for patients on oral anticoagulation after coronary stent implantation. However, robust evidence is lacking for some of the recommendations, and especially for new oral anticoagulants and new antiplatelets few or no data are available. This review addresses some of the critical points of the guidelines and discusses potential advantages of new anticoagulants in patients with atrial fibrillation after stent implantation.
No takes yet. Share an insight, caveat, or question.
Mischke et al. (2012) conducted a review in Atrial fibrillation and coronary artery disease. Anticoagulant and antiplatelet therapy was evaluated. New oral anticoagulants such as apixaban and dabigatran may offer a safer alternative to warfarin in patients with atrial fibrillation and coronary artery disease requiring antiplatelet therapy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: