Antiplatelet Therapy in Patients Requiring Oral Anticoagulation and Undergoing Percutaneous Coronary Intervention

Interv Cardiol Clin. 2024 Oct;13(4):527-541. doi: 10.1016/j.iccl.2024.07.001. Epub 2024 Aug 3.

Abstract

Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is fundamental in all patients undergoing percutaneous coronary intervention (PCI) to prevent coronary thrombosis. In patients with atrial fibrillation (AF), an oral anticoagulant gives protection against ischemic stroke or systemic embolism. AF-PCI patients are at high bleeding risk and decision-making regarding the optimal antithrombotic therapy remains challenging. Dual antithrombotic therapy (DAT) has been shown to reduce bleeding events but at the cost of a higher risk of stent thrombosis. Further studies are needed to clarify the optimal duration of triple antithrombotic therapy (TAT) or DAT and the role of more potent antiplatelet drugs.

Keywords: Antiplatelet; Atrial fibrillation; Bleeding; Dual antithrombotic therapy; Oral anticoagulant; Percutaneous coronary intervention; Thrombosis; Triple antithrombotic therapy.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants* / administration & dosage
  • Anticoagulants* / therapeutic use
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / drug therapy
  • Coronary Artery Disease / surgery
  • Coronary Thrombosis / prevention & control
  • Dual Anti-Platelet Therapy / methods
  • Hemorrhage / chemically induced
  • Hemorrhage / prevention & control
  • Humans
  • Percutaneous Coronary Intervention* / methods
  • Platelet Aggregation Inhibitors* / administration & dosage
  • Platelet Aggregation Inhibitors* / therapeutic use

Substances

  • Platelet Aggregation Inhibitors
  • Anticoagulants