Atrial Fibrillation and Percutaneous Coronary Intervention: Stroke, Thrombosis, and Bleeding
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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.
KeywordsAtrial Fibrillation Warfarin Percutaneous Coronary Intervention Acute Coronary Syndrome Clopidogrel
Sunil Rao is a consultant for The Medicines Company, Terumo Medical, Bristol-Myers Squibb, AstraZeneca, Sanofi-Aventis, and Daiichi Sankyo Lilly. He has received honoraria and payment for development of educational presentations from The Medicines Company, Sanofi-Aventis, and Bristol-Myers Squibb. He has had travel/accommodation expenses covered by The Medicines Company, Terumo Medical, Sanofi-Aventis, Bristol-Myers Squibb, and AstraZeneca.
Antonio Gutierrez reports no potential conflict of interest relevant to this article.
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