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CC BY 4.0 · TH Open 2020; 04(04): e332-e343
DOI: 10.1055/s-0040-1719081
Review Article

Novel Dual Therapy: A Paradigm Shift in Anticoagulation in Patients of Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Akshyaya Pradhan 
1   Department of Cardiology, King George Medical University, Lucknow, Uttar Pradesh, India
,
Monika Bhandari
1   Department of Cardiology, King George Medical University, Lucknow, Uttar Pradesh, India
,
Pravesh Vishwakarma
1   Department of Cardiology, King George Medical University, Lucknow, Uttar Pradesh, India
,
Rishi Sethi
1   Department of Cardiology, King George Medical University, Lucknow, Uttar Pradesh, India
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Abstract

Patients with atrial fibrillation (AF) on long-term oral anticoagulation (OAC) either have underlying coronary artery disease or suffer from acute coronary syndromes necessitating a percutaneous coronary intervention (PCI). In such a scenario, an amalgamation of antiplatelet and antithrombotic therapy (conventionally called as “triple therapy”) is obligatory for preventing coronary ischemia and stroke. But such ischemic benefits are accrued at the cost of increased bleeding. We also now know that bleeding events following PCI are related to increased mortality. Balancing the bleeding and ischemic risks is often a clinical dilemma. With the advent of novel oral anticoagulants (NOAC's) with preserved efficacy and attenuated bleeding rates, anticoagulation in AF is undergoing paradigm shift. The spotlight is now shifting from conventional triple therapy (vitamin-K antagonist + dual antiplatelet therapy [VKA + DAPT]) to novel dual therapy (NOAC + single antiplatelet therapy [SAPT]) in situation of anticoagulated AF patients undergoing PCI. Such a strategy aims to ameliorate the higher bleeding risk with conventional VKA's while retaining the ischemic benefits. In this review, we briefly discuss the need for combination therapy, trials of novel dual therapy, strategies for mitigating bleeding, the current guidelines, and the future perspectives in AF undergoing PCI with stent(s).

Keywords

atrial fibrillation - novel oral anticoagulants - high bleeding risk - randomized control trial - HAS-BLED score


Publikationsverlauf

Eingereicht: 21. Mai 2020

Angenommen: 23. September 2020

Artikel online veröffentlicht:
31. Oktober 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York

 

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