Document Detail


Prevention of thromboembolism in the patient with acute coronary syndrome and atrial fibrillation: the clinical dilemma of triple therapy.
MedLine Citation:
PMID:  24284976     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Atrial fibrillation in patients with acute coronary syndrome (ACS) is associated with a high thromboembolic event rate. Combined oral anticoagulant (OAC) and antiplatelet therapy (APT) are often used to reduce thromboembolic risk, recurrent coronary ischemic events, and stent thrombosis, despite the high bleeding risk. This review is timely with the recent introduction of novel OACs (NOACs), more potent antiplatelet agents, and second-generation coronary stents with a lower risk of late stent thrombosis, and considers strategies and new opportunities to reduce both thrombotic events and bleeding.
RECENT FINDINGS: The benefits of NOACs in patients with atrial fibrillation have been shown in recent studies. New evidence indicates that single rather than dual APT may be adequate when an OAC is used in a patient with a recent coronary stent. Limited evidence suggests a NOAC is preferable to warfarin when additional APT is also required.
SUMMARY: The implications of the new findings are to indicate strategies for more effective antithrombotic therapy, while minimizing the risk of major bleeding in patients with ACS and atrial fibrillation. However, additional research studies are required to further optimize treatment strategies in this high-risk population.
Authors:
David Fitchett; Atul Verma; John Eikelboom; Mina Madan; Eric Cohen; Alan Bell; Paul Dorian
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-26
Journal Detail:
Title:  Current opinion in cardiology     Volume:  -     ISSN:  1531-7080     ISO Abbreviation:  Curr. Opin. Cardiol.     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8608087     Medline TA:  Curr Opin Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
aSt Michael's Hospital bSouthlake Hospital, Newmarket cHamilton General Hospital, McMaster University, Hamilton dSunnybrook Hospital, University of Toronto eUniversity of Toronto, Toronto, Ontario, Canada.
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