TY - JOUR
T1 - Antithrombotic treatment in patients with atrial fibrillation and acute coronary syndromes
T2 - results of the European Heart Rhythm Association survey
AU - Lane, Deirdre A
AU - Dagres, Nikolaos
AU - Dan, Gheorghe-Andrei
AU - García Seara, Javier
AU - Iliodromitis, Konstantinos
AU - Lenarczyk, Radoslaw
AU - Lip, Gregory Y H
AU - Mansourati, Jacques
AU - Marín, Francisco
AU - Scherr, Daniel
AU - Potpara, Tatjana S
PY - 2019/7
Y1 - 2019/7
N2 - The management of an acute coronary syndrome (ACS) in a patient with existing atrial fibrillation (AF) often presents a management dilemma both in the acute phase and post-ACS, since the majority of AF patients will already be receiving oral anticoagulation (OAC) for stroke prevention and will require further antithrombotic treatment to reduce the risk of in-stent thrombosis or recurrent cardiac events. Current practice recommendations are based largely on consensus option as there is limited evidence from randomized controlled trials. Prior to the launch of the new European Heart Rhythm Association (EHRA) consensus document, a survey was undertaken to examine current clinical management of these patients across centres in Europe. Forty-seven centres submitted valid responses, with the majority (70.2%) being university hospitals. This EHRA survey demonstrated overall the management of ACS in AF patients is consistent with the available guidance. Most centres would use triple therapy for a short duration (4 weeks) and predominantly utilize a strategy of OAC (vitamin K antagonist, VKA or non-vitamin K antagonist oral anticoagulant, NOAC) plus aspirin and clopidogrel, followed by dual therapy [(N)OAC plus clopidogrel] until 12 months post-percutaneous coronary intervention, followed by (N)OAC monotherapy indefinitely. Where NOAC was used in combination with antiplatelet(s), the lower dose of the respective NOAC was preferred, in accordance with current recommendations.
AB - The management of an acute coronary syndrome (ACS) in a patient with existing atrial fibrillation (AF) often presents a management dilemma both in the acute phase and post-ACS, since the majority of AF patients will already be receiving oral anticoagulation (OAC) for stroke prevention and will require further antithrombotic treatment to reduce the risk of in-stent thrombosis or recurrent cardiac events. Current practice recommendations are based largely on consensus option as there is limited evidence from randomized controlled trials. Prior to the launch of the new European Heart Rhythm Association (EHRA) consensus document, a survey was undertaken to examine current clinical management of these patients across centres in Europe. Forty-seven centres submitted valid responses, with the majority (70.2%) being university hospitals. This EHRA survey demonstrated overall the management of ACS in AF patients is consistent with the available guidance. Most centres would use triple therapy for a short duration (4 weeks) and predominantly utilize a strategy of OAC (vitamin K antagonist, VKA or non-vitamin K antagonist oral anticoagulant, NOAC) plus aspirin and clopidogrel, followed by dual therapy [(N)OAC plus clopidogrel] until 12 months post-percutaneous coronary intervention, followed by (N)OAC monotherapy indefinitely. Where NOAC was used in combination with antiplatelet(s), the lower dose of the respective NOAC was preferred, in accordance with current recommendations.
KW - Acute coronary syndrome
KW - Anticoagulation
KW - Atrial fibrillation
KW - Dual antiplatelets
KW - EHRA survey
KW - Non-vitamin antagonist oral anticoagulants
KW - Triple therapy
KW - Vitamin K antagonist
UR - http://www.scopus.com/inward/record.url?scp=85072026061&partnerID=8YFLogxK
U2 - 10.1093/europace/euz033
DO - 10.1093/europace/euz033
M3 - Journal article
C2 - 30874724
SN - 1099-5129
VL - 21
SP - 1116
EP - 1125
JO - Europace
JF - Europace
IS - 7
ER -