Triple Antithrombotic Therapy for Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Prog Cardiovasc Dis. 2018 Jan-Feb;60(4-5):524-530. doi: 10.1016/j.pcad.2018.01.008. Epub 2018 Feb 3.

Abstract

Dual antiplatelet therapy (DAPT) has been the cornerstone of antithrombotic management for patients undergoing percutaneous coronary intervention (PCI). However, approximately 10% of these patients have concomitant atrial fibrillation (AF) and require chronic oral anticoagulant (OAC) in addition to DAPT. This traditional "triple therapy" has been associated with a three to four-fold increased risk of bleeding. The safety of non-vitamin K OAC (NOAC)-based strategies, using a NOAC plus a P2Y12 inhibitor, has been compared to vitamin K antagonist (VKA)-based triple therapy in the PIONEER AF-PCI and REDUAL PCI randomized trials, both of which have demonstrated that NOAC-based strategies are safer and provide an attractive alternative to VKA-based triple therapy among AF patients who undergo PCI. This article reviews the rationale, evidence, and recent evaluation of triple antithrombotic therapy among AF patients undergoing PCI.

Keywords: Atrial fibrillation; Novel oral anticoagulation; Percutaneous coronary intervention; Review; Rivaroxaban.

Publication types

  • Review

MeSH terms

  • Anticoagulants* / classification
  • Anticoagulants* / pharmacology
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / drug therapy*
  • Coronary Disease / complications
  • Coronary Disease / surgery*
  • Drug Therapy, Combination / methods
  • Humans
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / methods
  • Risk Adjustment / methods*

Substances

  • Anticoagulants