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Nadjib Hammoudi, Gilles Montalescot, The times they are a changin', European Heart Journal, Volume 39, Issue 19, 14 May 2018, Pages 1736–1739, https://doi.org/10.1093/eurheartj/ehy216
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Extract
This editorial refers to ‘Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of randomized clinical trials’†, by H.B. Golwala et al., on page 1726.
Antithrombotic strategies in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) are evolving. Oral anticoagulation (OAC) has been shown to be superior to dual antiplatelet therapy (DAPT) in preventing stroke in patients with AF, while DAPT has been shown to be superior to OAC in preventing stent thrombosis and ischaemic events in patients undergoing coronary stenting. In patients presenting both conditions, covering both risks by cumulating both treatments, the so-called triple therapy (TT), has been the rule for many years, supported by the clinical practice guidelines. However, studies, whether randomized or not, have consistently shown that TT dramatically increases the bleeding risk compared with a treatment combining OAC with only one antiplatelet agent, the so-called double therapy (DT).1 , 2
- antiplatelet agents
- aspirin
- atrial fibrillation
- warfarin
- fibrinolytic agents
- percutaneous coronary intervention
- stents
- ischemia
- hemorrhage
- cerebrovascular accident
- ischemic stroke
- percutaneous transluminal coronary angioplasty
- patient discharge
- guidelines
- stent thrombosis
- prasugrel
- ticagrelor
- risk of excessive or recurrent bleeding
- european society of cardiology
- cha2ds2-vasc score
- dual anti-platelet therapy
- direct oral anticoagulants