In our most popular poll thus far, over 500 people responded with their choice of antiplatelet and antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting. The recently updated atrial fibrillation guidelines¹ now give a Class IIa recommendation to the use of dual therapy after percutaneous coronary intervention (PCI) as reasonable choices after PCI to reduce the risk of bleeding compared with triple therapy. It appears these recommendations are slowly translating to clinical care because about one third (35%) of respondents indicated they would use dual therapy with clopidogrel and anticoagulation without aspirin. In contrast, triple therapy with aspirin and clopidogrel and either warfarin or a NOAC was the choice of treatment for more than half of respondents (54%). Use of anticoagulation with one of the newer antiplatelet agents, ticagrelor or prasugrel, was chosen in a small minority, only about 10% of respondents, likely due to the increased risk of bleeding.

References

1. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2019;74:104-132.

Keywords: Acute Coronary Syndrome, Platelet Aggregation Inhibitors, Warfarin, Aspirin, Atrial Fibrillation, Fibrinolytic Agents, Ticlopidine, Adenosine, Percutaneous Coronary Intervention, Hemorrhage

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