Antithrombotic therapy in atrial fibrillation: stop triple therapy and start optimizing dual therapy?
Based on recent studies, we want to provoke thoughts on how to further optimize research on antiplatelet treatment in patients on oral anticoagulation (OAC).
One in three patients suffering from atrial fibrillation (AF) develops concomitant coronary artery disease. Hence, these patients are likely to undergo percutaneous coronary intervention (PCI). AF often leads to an indication for OAC, and after PCI, a dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 inhibitor is recommended. These overlapping recommendations led to many patients with AF after PCI and/or acute coronary syndrome (ACS) being on “triple therapy” (TT) consisting of OAC and DAPT. In TT, both non-vitamin-K-anticoagulants (NOACs) and vitamin-K-antagonists (VKA) are used. TT is thought to be effective in preventing thrombotic events, but known to be associated with risks of bleeding. This is of interest, as AF patients are often elderly and, therefore, at greater risk for bleeding complications....
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