Dual antithrombotic therapy for atrial fibrillation and PCI

Patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) need oral anticoagulation to prevent cardioembolic events and antiplatelet therapy to prevent coronary events. 1 Capodanno D Huber K Mehran R et al. Management of antithrombotic therapy in atrial fibrillation patients undergoing PCI: JACC state-of-the-art review. J Am Coll Cardiol. 2019; (in press). Crossref Scopus (66) Google Scholar In this context, three trials of rivaroxaban (PIONEER-AF PCI), 2 Gibson CM Mehran R Bode C et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med. 2016; 375: 2423-2434 Crossref PubMed Scopus (865) Google Scholar dabigatran (RE-DUAL PCI), 3 Cannon CP Bhatt DL Oldgren J et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med. 2017; 377: 1513-1524 Crossref PubMed Scopus (709) Google Scholar and apixaban (AUGUSTUS) 4 Lopes RD Heizer G Aronson R et al. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med. 2019; 380: 1509-1524 Crossref PubMed Scopus (409) Google Scholar showed that combining a non-vitamin K antagonist oral anticoagulant (NOAC) and a P2Y12 inhibitor, a strategy known as dual antithrombotic therapy (DAT), reduces bleeding compared with triple antithrombotic therapy (TAT) consisting of a vitamin K antagonist (VKA), a P2Y12 inhibitor, and aspirin. 5 Capodanno D Mehran R Valgimigli M et al. Aspirin-free strategies in cardiovascular disease and cardioembolic stroke prevention. Nat Rev Cardiol. 2018; 15: 480-496 Crossref PubMed Scopus (120) Google Scholar Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trialIn patients with atrial fibrillation who had PCI, the edoxaban-based regimen was non-inferior for bleeding compared with the VKA-based regimen, without significant differences in ischaemic events. Full-Text PDF