Antithrombotic treatment in patients with atrial fibrillation and acute coronary syndromes

results of the European Heart Rhythm Association survey

Deirdre A Lane, Nikolaos Dagres, Gheorghe-Andrei Dan, Javier García Seara, Konstantinos Iliodromitis, Radoslaw Lenarczyk, Gregory Y H Lip, Jacques Mansourati, Francisco Marín, Daniel Scherr, Tatjana S Potpara

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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.

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clopidogrel
Acute Coronary Syndrome
Atrial Fibrillation
Vitamin K
Percutaneous Coronary Intervention
Therapeutics
Anticoagulants
Aspirin
Stents
Thrombosis
Randomized Controlled Trials
Stroke
Surveys and Questionnaires
N(4)-oleylcytosine arabinoside

Citer dette

@article{95fd7480e191421bb19b10b1b9b8ace2,
title = "Antithrombotic treatment in patients with atrial fibrillation and acute coronary syndromes: results of the European Heart Rhythm Association survey",
abstract = "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.",
author = "Lane, {Deirdre A} and Nikolaos Dagres and Gheorghe-Andrei Dan and {Garc{\'i}a Seara}, Javier and Konstantinos Iliodromitis and Radoslaw Lenarczyk and Lip, {Gregory Y H} and Jacques Mansourati and Francisco Mar{\'i}n and Daniel Scherr and Potpara, {Tatjana S}",
year = "2019",
month = "3",
day = "14",
doi = "10.1093/europace/euz033",
language = "English",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",

}

Antithrombotic treatment in patients with atrial fibrillation and acute coronary syndromes : results of the European Heart Rhythm Association survey. / Lane, Deirdre A; Dagres, Nikolaos; Dan, Gheorghe-Andrei; García Seara, Javier; Iliodromitis, Konstantinos; Lenarczyk, Radoslaw; Lip, Gregory Y H; Mansourati, Jacques; Marín, Francisco; Scherr, Daniel; Potpara, Tatjana S.

I: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 14.03.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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 - 2019/3/14

Y1 - 2019/3/14

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.

U2 - 10.1093/europace/euz033

DO - 10.1093/europace/euz033

M3 - Journal article

JO - Europace

JF - Europace

SN - 1099-5129

ER -