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A Tailored Antithrombotic Approach for Patients with Atrial Fibrillation Presenting with Acute Coronary Syndrome and/or Undergoing PCI: A Case Series

The combination of oral anticoagulants (OAC) and dual antiplatelet therapy (DAPT) is the mainstay for the treatment of patients with atrial fibrillation (AF) presenting with acute coronary syndrome (ACS) and/or undergoing PCI. However, this treatment leads to a significant increase in risk of bleedi...

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Autores principales: Giubilato, Simona, Lucà, Fabiana, Pozzi, Andrea, Caretta, Giorgio, Cornara, Stefano, Pilleri, Anna, Di Nora, Concetta, Amico, Francesco, Di Matteo, Irene, Favilli, Silvia, Rossini, Roberta, Riccio, Carmine, Colivicchi, Furio, Gulizia, Michele Massimo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9323399/
https://www.ncbi.nlm.nih.gov/pubmed/35887851
http://dx.doi.org/10.3390/jcm11144089
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author Giubilato, Simona
Lucà, Fabiana
Pozzi, Andrea
Caretta, Giorgio
Cornara, Stefano
Pilleri, Anna
Di Nora, Concetta
Amico, Francesco
Di Matteo, Irene
Favilli, Silvia
Rossini, Roberta
Riccio, Carmine
Colivicchi, Furio
Gulizia, Michele Massimo
author_facet Giubilato, Simona
Lucà, Fabiana
Pozzi, Andrea
Caretta, Giorgio
Cornara, Stefano
Pilleri, Anna
Di Nora, Concetta
Amico, Francesco
Di Matteo, Irene
Favilli, Silvia
Rossini, Roberta
Riccio, Carmine
Colivicchi, Furio
Gulizia, Michele Massimo
author_sort Giubilato, Simona
collection PubMed
description The combination of oral anticoagulants (OAC) and dual antiplatelet therapy (DAPT) is the mainstay for the treatment of patients with atrial fibrillation (AF) presenting with acute coronary syndrome (ACS) and/or undergoing PCI. However, this treatment leads to a significant increase in risk of bleeding. In most cases, according to the most recent guidelines, triple antithrombotic therapy (TAT) consisting of OAC and DAPT, typically aspirin and clopidogrel, should be limited to one week after ACS and/or PCI (default strategy). On the other hand, in patients with a high ischemic risk (i.e., stent thrombosis) and without increased risk of bleeding, TAT should be continued for up to one month. Direct oral anticoagulants (DOAC) in triple or dual antithrombotic therapy (OAC and P2Y12 inhibitor) should be favored over vitamin K antagonists (VKA) because of their favorable risk/benefit profile. The choice of the duration of TAT (one week or one month) depends on a case-by-case evaluation of a whole series of hemorrhagic or ischemic risk factors for each patient. Likewise, the specific DOAC treatment should be selected according to the clinical characteristics of each patient. We propose a series of paradigmatic clinical cases to illustrate the decision-making work-up in clinical practice.
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spelling pubmed-93233992022-07-27 A Tailored Antithrombotic Approach for Patients with Atrial Fibrillation Presenting with Acute Coronary Syndrome and/or Undergoing PCI: A Case Series Giubilato, Simona Lucà, Fabiana Pozzi, Andrea Caretta, Giorgio Cornara, Stefano Pilleri, Anna Di Nora, Concetta Amico, Francesco Di Matteo, Irene Favilli, Silvia Rossini, Roberta Riccio, Carmine Colivicchi, Furio Gulizia, Michele Massimo J Clin Med Article The combination of oral anticoagulants (OAC) and dual antiplatelet therapy (DAPT) is the mainstay for the treatment of patients with atrial fibrillation (AF) presenting with acute coronary syndrome (ACS) and/or undergoing PCI. However, this treatment leads to a significant increase in risk of bleeding. In most cases, according to the most recent guidelines, triple antithrombotic therapy (TAT) consisting of OAC and DAPT, typically aspirin and clopidogrel, should be limited to one week after ACS and/or PCI (default strategy). On the other hand, in patients with a high ischemic risk (i.e., stent thrombosis) and without increased risk of bleeding, TAT should be continued for up to one month. Direct oral anticoagulants (DOAC) in triple or dual antithrombotic therapy (OAC and P2Y12 inhibitor) should be favored over vitamin K antagonists (VKA) because of their favorable risk/benefit profile. The choice of the duration of TAT (one week or one month) depends on a case-by-case evaluation of a whole series of hemorrhagic or ischemic risk factors for each patient. Likewise, the specific DOAC treatment should be selected according to the clinical characteristics of each patient. We propose a series of paradigmatic clinical cases to illustrate the decision-making work-up in clinical practice. MDPI 2022-07-14 /pmc/articles/PMC9323399/ /pubmed/35887851 http://dx.doi.org/10.3390/jcm11144089 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Giubilato, Simona
Lucà, Fabiana
Pozzi, Andrea
Caretta, Giorgio
Cornara, Stefano
Pilleri, Anna
Di Nora, Concetta
Amico, Francesco
Di Matteo, Irene
Favilli, Silvia
Rossini, Roberta
Riccio, Carmine
Colivicchi, Furio
Gulizia, Michele Massimo
A Tailored Antithrombotic Approach for Patients with Atrial Fibrillation Presenting with Acute Coronary Syndrome and/or Undergoing PCI: A Case Series
title A Tailored Antithrombotic Approach for Patients with Atrial Fibrillation Presenting with Acute Coronary Syndrome and/or Undergoing PCI: A Case Series
title_full A Tailored Antithrombotic Approach for Patients with Atrial Fibrillation Presenting with Acute Coronary Syndrome and/or Undergoing PCI: A Case Series
title_fullStr A Tailored Antithrombotic Approach for Patients with Atrial Fibrillation Presenting with Acute Coronary Syndrome and/or Undergoing PCI: A Case Series
title_full_unstemmed A Tailored Antithrombotic Approach for Patients with Atrial Fibrillation Presenting with Acute Coronary Syndrome and/or Undergoing PCI: A Case Series
title_short A Tailored Antithrombotic Approach for Patients with Atrial Fibrillation Presenting with Acute Coronary Syndrome and/or Undergoing PCI: A Case Series
title_sort tailored antithrombotic approach for patients with atrial fibrillation presenting with acute coronary syndrome and/or undergoing pci: a case series
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9323399/
https://www.ncbi.nlm.nih.gov/pubmed/35887851
http://dx.doi.org/10.3390/jcm11144089
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