Management of Antithrombotic Therapy in Atrial Fibrillation Patients Undergoing PCI: JACC State-of-the-Art Review.


Journal Article (Review)

Most patients with atrial fibrillation (AF) and risk factors for stroke require oral anticoagulation (OAC) to decrease the risk of stroke or systemic embolism. This is now best achieved with direct oral anticoagulants that decrease the risk of intracranial bleeding compared with vitamin K antagonists. Of note, approximately 5% to 10% of patients undergoing percutaneous coronary intervention have AF, which complicates antithrombotic therapy in daily practice, because the guidelines recommend that these patients also receive dual antiplatelet therapy (DAPT) to reduce the risk of ischemic complications. However, combining OAC with DAPT, a strategy also known as triple antithrombotic therapy, is known to increase the risk of bleeding compared with the use of OAC or DAPT alone. Studies of direct oral anticoagulants are now emerging that show the favorable safety profile of double antithrombotic therapy with OAC and a P2Y12 inhibitor in comparison with triple antithrombotic therapy including the use of vitamin K antagonists. The scope of this review is to provide an update on this topic as well as to discuss future directions in the management of antithrombotic therapy after percutaneous coronary intervention in AF patients requiring chronic OAC.

Full Text

Duke Authors

Cited Authors

  • Capodanno, D; Huber, K; Mehran, R; Lip, GYH; Faxon, DP; Granger, CB; Vranckx, P; Lopes, RD; Montalescot, G; Cannon, CP; Ten Berg, J; Gersh, BJ; Bhatt, DL; Angiolillo, DJ

Published Date

  • July 9, 2019

Published In

Volume / Issue

  • 74 / 1

Start / End Page

  • 83 - 99

PubMed ID

  • 31272556

Pubmed Central ID

  • 31272556

Electronic International Standard Serial Number (EISSN)

  • 1558-3597

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2019.05.016


  • eng

Conference Location

  • United States