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Antithromboembolic Strategies for Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

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Abstract

We set out to synthesize available data on antithrombotic strategies for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), with a focus on triple antithrombotic therapy (triple therapy [TT]; dual antiplatelet therapy plus an anticoagulant) versus dual therapy (DT; one antiplatelet agent and an anticoagulant). We searched OVID MEDLINE and PubMed from January 2005 to September 2017 using the search terms oral anticoagulant, triple therapy, dual therapy, acute coronary syndrome, percutaneous coronary intervention, and atrial fibrillation (limited to randomized controlled trials, observational studies, English language, minimum 6–12 months of follow-up, minimum 100 human patients). We excluded surveys, literature reviews, articles not directly related to TT versus DT, incomplete studies, and short-term in-hospital studies. All eligible studies were reviewed to evaluate possible antithrombotic management strategies for patients with AF undergoing PCI. Extracted studies were categorized according to the specific anticoagulant (vitamin K antagonist vs. direct-acting oral anticoagulant) and P2Y12 inhibitor used. Each category review was followed by a discussion providing insight into the quality of evidence and implications for practice. We found that the risk of bleeding with TT was higher than with DT, without demonstrated added benefit of reducing major adverse cardiovascular events. TT use should be minimized in patients with high bleeding risk, and patient-specific factors should be critically analyzed to select appropriate antiplatelet and anticoagulant agents.

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Authors and Affiliations

  1. Department of Pharmacy Services, UK HealthCare, University of Kentucky College of Pharmacy, 800 Rose Street, H110, Lexington, KY, 40536, USA

    Ayesha Ather & Ashley Schenk

  2. Department of Pharmacy, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Benjamin Laliberte

  3. Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, ATRIUM Cardiology Collaborative, 20 N Pine Street, Office S428, Baltimore, MD, 21201, USA

    Brent N. Reed

  4. Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, ATRIUM Cardiology Collaborative, 20 N Pine Street, Office S447, Baltimore, MD, 21201, USA

    Kristin Watson

  5. Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, ATRIUM Cardiology Collaborative, 20 N Pine Street, Pharmacy Hall Rm S430, Baltimore, MD, 21201, USA

    Sandeep Devabhakthuni

  6. Division of Cardiovascular Medicine, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD, 21201, USA

    Vincent Y. See

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  1. Ayesha Ather
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At the time of publication, Dr. Benjamin Laliberte is an employee of Novartis Pharmaceuticals Corporation. Ayesha Ather, Brent Reed, Kristin Watson, Sandeep Devabhakthuni, Ashley Schenk, and Vincent See have no conflicts of interest that might be relevant to the contents of this manuscript.

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Ather, A., Laliberte, B., Reed, B.N. et al. Antithromboembolic Strategies for Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention. Am J Cardiovasc Drugs 18, 441–455 (2018). https://doi.org/10.1007/s40256-018-0287-y

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