Cerebrovascular Disease and Stroke

Current Treatment Options in Cardiovascular Medicine

, Volume 13, Issue 3, pp 203-214

First online:

Atrial Fibrillation and Percutaneous Coronary Intervention: Stroke, Thrombosis, and Bleeding

  • Antonio GutierrezAffiliated withDepartment of Medicine, Duke University School of Medicine Email author 
  • , Sunil V. RaoAffiliated withDuke Clinical Research Institute

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Opinion statement

Currently available data suggest that patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with stenting who do not continue oral anticoagulation are at increased risk for mortality and morbidity. In this patient population, therapy directed at reducing both thromboembolism (via oral anticoagulation) and stent thrombosis (via dual antiplatelet therapy) is necessary but is associated with an increased risk for bleeding. For patients with a high risk for thromboembolism based on published AF risk scores, the use of bare metal stents is recommended to minimize the duration of triple therapy. During the time period when triple therapy is used, the International Normalized Ratio (INR) should be maintained at the lower end of therapeutic range (2.0), and lower dose aspirin should be used. Finally, as newer oral anticoagulation agents such as dabigatran and rivaroxaban become available, further research will be required to determine their safety and efficacy in patients with AF undergoing PCI with stenting.